| TMA Action May 2,
|| News and Insights from Texas Medical
INSIDE: TMA Urges Congress to Extend CHIP Funding
TMA Urges Congress
to Extend CHIP Funding Beyond 2015
TMA Opposes Proposed Overreaching Agency
on NPP Regs With New TMA Seminar
Stage 2 Meaningful Use Incentive Calculator Now
Sheds Light on Industry Payments to Physicians
Umbilical Cord Blood Banking
Physicians Help Create a
File Your Franchise Tax Reports by May
Offers Newborn Screening Requirement Guidance
Memorial Hermann, DocbookMD Deal Connects Houston
Apply for the 2013-14 Texas Physician Practice
Quality Improvement Award
Four Reasons to Attend the Texas Health Home
Physicians Foundation's 2014 National Physician Survey
This Month in Texas
TMA Urges Congress to Extend CHIP Funding Beyond 2015
TMA signed onto a March of Dimes and Texas Pediatric Society letter asking Gov. Rick Perry to urge the Texas congressional
delegation to support continued Children's Health Insurance Program (CHIP)
funding beyond 2015. Though the program will run through 2019, federal funding
for CHIP expires Oct. 1, 2015, unless Congress extends it.
"Thanks to leaders like you, between 84-87 percent of children in Texas were
insured in 2012 — a record high. Texas CHIP is a major part of this success
story, providing health coverage to over half a million Texas children each
month for a total of 999,838 Texas children served (in 2012)," the letter
Since CHIP's inception in 1997, it has halved the number of low-income,
uninsured children nationwide — from 25 percent in 1997 to 13 percent in 2012 —
and has improved health outcomes and access to care for children and pregnant
women, TMA and dozens of other organizations that signed the letter told the
Texas CHIP also provides women with prenatal health care and preventive
services during pregnancy.
"If Congress doesn't act, more than 7.8 million children nationwide — more
than 50 percent of those insured by CHIP — would lose their coverage by 2016.
Likewise, pregnant women enrolled in CHIP could be left without other sources of
prenatal care, jeopardizing the health of their newborns. We fear that, without
CHIP, our state's uninsured rate would increase significantly and the health of
children and families in Texas would be in jeopardy," the letter concludes.
TMA Opposes Proposed Overreaching Agency Rules
TMA President Stephen L. Brotherton, MD, wrote formal comment letters for
the association opposing two state agencies' proposed rules that go too
TMA and the Texas Neurological Society wrote a formal letter opposing a Texas State Board of Dental Examiners'
(TSBDE's) proposal to allow dentists to diagnose and treat sleep apnea.
"If a dentist practices outside the scope of dentistry, such as diagnosing or
independently treating a sleep disorder, he or she is, by definition, practicing
medicine unlawfully," Dr. Brotherton wrote. "It is imperative that diagnoses of
the presence or the absence of sleep disorders, including but not limited to
benign snoring and sleep apnea, be made by a qualified Texas-licensed physician,
in order to protect the health and safety of Texas' patients."
In the letter, TMA cites a 2012 joint policy issued by the American Academy
of Sleep Medicine (AASM) and the American Academy of Dental Sleep Medicine
(AADSM). The policy asserts, "The evaluation and diagnosis of sleep apnea must
be made by a physician, and therapies for sleep apnea, including positive airway
pressure and oral appliance therapy, must be prescribed by a qualified
The letter concludes: "The rules as proposed would be in violation of the
Texas Medical Practice Act and the Texas Dental Practice Act. We urge the TSBDE
to consider these comments and modify its proposed rules as recommended in this
letter, in conformity with the Texas Dental Practice Act, the Texas Medical
Practice Act, and the policy statements of the Texas Medical Board (TMB), AASM,
Also, TMA wrote a letter to oppose a TMB rule that would require the supervisor
of a physician assistant temporary license holder to not only be a
Texas-licensed physician with an unrestricted license but also not to have been
the subject of a disciplinary order, other than one administrative in
"A Texas-licensed physician who holds an unrestricted medical license is, by
the TMB's own assessment, authorized to perform any medical service or procedure
that falls within the scope of his or her license in the state of Texas," Dr.
Brotherton wrote. "Thus, he or she should be capable of providing 'adequate
supervision' of a physician assistant temporary license holder. The fact that a
physician once, perhaps many years ago, had a disciplinary order does not change
The letter states that "establishing a requirement that the supervisor must
have never been the subject of a disciplinary order is not the appropriate way
to measure the physician's current basic competency."
TMA urges the medical board not to adopt the proposed amendment and adds,
"Should the TMB choose to move forward with its proposal over TMA's objection,
TMA recommends that the TMB, at a minimum, limit the rule's language regarding
ineligibility based upon the supervisory physician's past disciplinary order to
disciplinary orders that occurred within the past year."
Brush Up on NPP Regs With New TMA Seminar
With input from TMA, the 2013 Texas Legislature simplified the process by
which physicians supervise and delegate to nonphysician practitioners (NPPs).
These changes define a prescriptive authority agreement as a separate and
distinct arrangement, and scrap the definition of medically underserved area.
These changes will enable physicians to lead physician assistants and advanced
practice registered nurses more effectively in collaborative practice.
TMA's new evening seminar, NPP Regulations: Rules You
Need to Know, will teach you and your staff about the new required
prescriptive authority agreements, quality assurance plans, and more.
Physicians, NPPs, and office managers should all attend to learn their altered
responsibilities under the new supervision framework and how to avoid legal
pitfalls. Hors d'oeuvres will be served during check-in, and all attendees will
receive a sample prescriptive authority agreement.
Can't attend in person? On May 15, TMA will webcast this seminar
over the Internet. You can watch and participate just like you would in
To reflect recent changes in the law, TMA has released an updated second
edition of its best-selling publication Nonphysician Practitioners: Hiring, Billing, and Delegation of
Duties for a Nonphysician Practitioner. Contact TMA at (800) 880-1300,
ext. 1415, if you recently purchased the first edition of this publication.
Visit the TMA Education Center to attend a live seminar in your area,
register for the May 15 live webcast seminar, or purchase the publication.
Stage 2 Meaningful Use Incentive Calculator Now Available
Determine your incentive payment eligibility in the Stage 2 meaningful use electronic health record (EHR)
incentive programs with the new calculator developed by the Centers for Medicare &
Medicaid Services. Just enter and review your data for each meaningful use
Getting started with the calculator involves four easy steps:
- Select provider type ("eligible professional" for physicians).
- Answer questions on your meaningful use core objectives.
- Answer questions on your meaningful use menu objectives.
- Receive your results.
Remember: The calculator is a tool that allows you to determine whether you
are meeting the meaningful use metrics and are able to successfully attest to
meaningful use. Once you are certain you have met the requirements, you can then
meaningful use for the 2014 quarter you have chosen.
Physicians who need assistance with the EHR incentive program may receive
consulting help from one of four Texas regional extension centers (RECs). The
RECs are qualified to help physicians navigate the complexities of the program.
Check out TMA's REC Resource Center to find out which REC serves your
For more information about EHRs or other health information technology
issues, email TMA's HIT Department or
call (800) 880-5720.
Law Sheds Light on Industry Payments to Physicians
Later this year under the Physician Payments Sunshine Act, the Centers for Medicare & Medicaid Services
(CMS) will make public physician payments reported by manufacturers of drugs,
medical devices, and biologicals that participate in federal health care
The law, which took effect Aug. 1, 2013, is part of the Affordable Care Act
and requires manufacturers and group purchasing organizations to report
ownership interests held by physicians and their immediate family members.
On Feb. 18, CMS opened payments registration and data submission for
applicable manufacturers and group purchasing organizations for the 2013
The American Medical Association anticipates that between June and August,
CMS will launch an online portal where physicians can sign up to be notified
when their financial disclosures are available for review and correction. At
that time, physicians can review their reports and challenge them if they are
false, inaccurate, or misleading. CMS says it will provide physicians access to
their consolidated financial disclosures for the prior calendar year. According
to AMA, CMS will release most of the data on a public website by September.
AMA's online toolkit features a webinar on preparing for the Sunshine Act,
an overview of the financial interactions and ownership interests that will be
reported, an explanation of the excluded financial interactions, answers to
frequently asked questions, and a summary of the act's key provisions.
AMA advises physicians to:
- Ensure all financial and conflict-of-interest disclosures required by
employers and other entities that provide funding are current and updated
- Update professional information and ensure the correct specialty
- Learn what financial transfers and ownership interests must be reported by
drug and device manufacturers and group purchasing organizations; and
- Ask industry contacts to provide transfer information in advance for an
opportunity to correct the information before it's transmitted to the
The Open Payments Mobile for Physicians app allows you to capture and
confidentially collect information on reportable transfers between you and
industry representatives. This information comes in handy should you need to
challenge any inaccurate information reported to the government. Download the
app on your Apple or Android device.
Note: The Sunshine Act stipulates payments or other transfers of value
provided as compensation for speaking at a continuing medical education (CME)
program are not required to be reported if the following conditions are
- The activity meets the requirements of the continuing education accrediting
agency, e.g., the Accreditation Council for Continuing Medical Education;
- The pharmaceutical or device company does not pay the speaker directly; and
- The pharmaceutical or device company does not choose the speaker or give the
CME provider a group of speakers to consider for the activity.
Most of the information contained in the reports will be available on a
public, searchable website.
Umbilical Cord Blood Banking
Umbilical cord blood stem cell transplants are used to treat a variety of
oncologic, genetic, hematologic, and immunodeficiency disorders. Physicians have
an important role in educating, counseling, and offering umbilical cord blood
donation and storage options to patients.
TMA has provided the following information to help you inform and educate
your patients about cord blood banking.
Benefits of Cord Blood Collection and Use
blood is the blood that drains from the placenta and umbilical cord after the
delivery of a stable infant. Cord blood can be collected without risk to mother
or baby. Cord blood stem cells are not embryonic stem cells. If not donated to a
bank, this material is discarded as waste. Umbilical cord blood has many
advantages over traditional stem cell sources, but one of the most important is
its quick availability once a match is identified for a patient.
Public Versus Private Banking
Cord blood banking can be
done with a private or public cord blood bank. There is no cost to donate to
public cord blood banks, and donated units are available for any patient listed
on the national registry.
Private banks charge patients a collection and
storage fee. Collected units are available only for use by the person who
provided the cord blood or her immediate family members, greatly limiting the
potential usefulness of the blood. Patients also should be aware that private
banks may vary greatly in their processing and storage procedures and quality
Donating Cord Blood
there are two public banking facilities that collect, process, and store
umbilical cord blood: the Texas
Cord Blood Bank and MD Anderson Cord Blood Bank. These banks partner with
hospitals locally and throughout Texas for the collection of donated cord blood.
Donation services are not offered in all hospitals or all cities. These participating hospitals accept
Patients should check with their intended delivery hospital
before the 34th week of pregnancy if they wish to have their cord blood donated.
If the patient’s hospital does not participate in the program, the patient may
contact the Be the Match registry between her 28th and 34th week of
pregnancy to request a cord blood donation kit.
Among racial and ethnic
minority populations, including African-American and Hispanics, there is a
disproportionate need for stem cell transplants due to the lack of minority
donors on the cord blood and bone marrow donor registries. Educating these
patients on cord blood donation and encouraging all eligible patients to donate
is recommended to ensure an adequate supply for Texas’ large and diverse
State Requirements and Resources for
In 2007, House Bill 709 was passed requiring physicians
practicing in Texas to provide a patient a brochure on umbilical cord blood
options “before the third trimester of the woman’s pregnancy or as soon as
The Texas Department of State Health Services
(DSHS) provides the brochure Information on
Umbilical Cord Blood Banking and Donation in English and Spanish, free of
To order brochure copies, visit www.dshs.state.tx.us/mch/, call (512) 250-7116, or fax DSHS
using Form No. AG-30 to (512) 250-9360. In the blank text box
provided at the top of the fax form, include your name, address, stock number
6-73, and quantity requested. Brochures will be mailed and delivered to your
office in approximately one week.
TMA Policy TMA Policy 45.017 Umbilical Cord Blood encourages
families to donate umbilical cord blood for public supply (Amended Res.
National Guidelines and Recommendations
Academy of Pediatrics, the American College of Obstetricians and Gynecologists
(ACOG), the American Medical Association, the American Society of Blood and
Marrow Transplantation (ASBMT), and the World Marrow Donor Association have
published guidelines regarding umbilical cord blood.
Key recommendations are:
- Parents should be encouraged to donate umbilical cord blood to public banks,
which accept donations free of charge and provide stem cells to anyone who needs
- Cord blood banking should be recommended through the Related Donor Cord
Blood Program when the donor's sibling has an illness that may be treated with a
cord blood transplant (this program stores cord blood units for the exclusive
use of the donor family).
- Private banking for unidentified possible future use is not currently
Additional Information and Resources
Academy of Family Physicians — Umbilical Cord Blood: A Guide for Primary Care
ACOG — Umbilical Cord Blood Banking: Committee Opinion
AMA — Opinion: Umbilical Cord Blood Banking
ASBMT — Should You Store Your
Baby's Umbilical Cord Blood?
Be the Match — Cord Blood and Transplants
Sources: Be the Match. Key Facts. Jan 2013.
Physicians Help Create a Healthy Economy
Physician practices add value to Texas' economy by producing tens of
billions of dollars in revenue each year and providing hundreds of thousands of
jobs. "The National Economic Impact of Physicians," a new study conducted for
the American Medical Association and state medical societies, found Texas'
48,314 practicing physicians boost the state's economy by supporting 522,619
jobs and generating $78.6 billion in economic activity.
TMA President Stephen L. Brotherton, MD, said, "Unlike last week's Medicare
payment data dump, these numbers are supported by solid analysis and reported in
rich context. The bottom line is that Texas' physician practices, without a
doubt, are good for the economic health of our communities and our state."
The economic benefit of doctors' offices goes beyond the hundreds of
thousands of direct jobs they support, including the quite-quantifiable ripple
effect of those jobs and tax dollars through the local economy.
"Physicians carry tremendous responsibility as skilled healers charged with
safeguarding healthy communities, but their positive impact isn't confined to
the exam room," said AMA President Ardis Dee Hoven, MD. "The new study
illustrates that physicians are strong economic drivers that are woven into
their local communities by the economic growth, opportunity, and prosperity they
The findings in Texas cover these four key economic barometers:
- Jobs: Each physician supported an average of 10.8 jobs and
contributed to a total of 522,619 jobs statewide.
- Output: Each physician generated an average of $1,627,498
in economic output and contributed to a total of $78.6 billion statewide.
- Wages and Benefits: Each physician supported an average of
$890,990 in total wages and benefits and contributed to a total of $43 billion
- Tax Revenues: Each physician supported $52,618 in local and
state tax revenues and contributed to a total of $2.5 billion statewide.
The report found that Texas physicians generate significantly more economic
output (i.e., medical and nonmedical sales revenues) than the legal industry;
produce more jobs than colleges, universities, and nursing homes combined; and
pay more in wages and benefits than all Texas hospitals.
Across the country, the nation's 720,000 practicing physicians support 9.9
million jobs, generate $1.6 trillion in economic activity, support $775 billion
in wages and benefits, and generate $65.2 billion in state and local tax
revenue. Visit the AMA website to view the full national report and an
interactive map of the United States.
"The National Economic Impact of Physicians" was prepared for AMA by IMS
File Your Franchise Tax Reports by May 15
Annual franchise tax reports are due May 15.
Beat the rush to file your franchise tax report or request an extension by using WebFile to electronically file reports.
DSHS Offers Newborn Screening Requirement Guidance
The College of American Pathologists (CAP) issued a new specimen tracking
requirement for CAP-accredited laboratories that submit newborn screening
specimens to the Texas Department of State Health Services (DSHS) laboratory for
testing. Phase I of the requirement applies to specimens submitted to a remote
testing laboratory for screening for congenital disorders in newborns.
CAP requires "a documented tracking system to ensure that all specimens are
submitted in compliance with timing requirements and that a result or other
appropriate notification is received indicating that the specimens were actually
To meet the requirement, DSHS recommends labs use the Texas Newborn
Screening Web Application (Neometrics).
Using the web application allows health professionals to:
- Enter patient demographic information.
- Search and print newborn screening result reports 24/7.
Once the DSHS lab receives and scans the electronic demographic information
for each newborn screen specimen into the Laboratory Information Management
System, it will appear in the health professional's web application account.
Note: Demographic entry of specimens is not necessary to view or retrieve result
The DSHS Laboratory Quality Assurance Group has consulted with CAP and
confirmed that health care professionals can meet the specimen tracking
requirement by acknowledging receipt of a result report for each specimen
Visit the DSHS remote data systems FAQ
page for more information about the Texas Newborn Screening Web Application.
Or call DSHS at (888) 963-7111, ext. 7333, or email NewbornScreeningLab@dshs.state.tx.us.
Memorial Hermann, DocbookMD Deal Connects Houston Physicians
DocbookMD has signed an agreement to deploy Docbook
Enterprise to MHMD Memorial Hermann Physician Network of Houston. This is a
big win not only for physicians at MHMD, who will gain significant communication
and workflow advantages, but also for the whole Houston community. DocbookMD,
the HIPAA-secure mobile communication app, provides the ability to connect
physicians at MHMD to one another as well as to other TMA-member physicians
This sets DocbookMD apart from other communication platforms. DocbookMD
gives physicians the ability to connect to other physicians and health care
resources within an entire region. Most technologies use a closed network that
allows physicians within a hospital or group to communicate securely only with
colleagues and staff who are inside that organization. But DocbookMD's guiding
vision has always been to break down the barriers that prevent physicians from
sharing critical communications with all of those involved in their patients'
DocbookMD is available to all TMA members as a free member
benefit. Across the country, more than 25,000 physicians in 40 states use
DocbookMD, further connecting the community of medicine. DocbookMD is available
for iPhone, iPad, and Android devices as well as PC and Mac via the new web
version. The app can be downloaded using the Apple App
Store or Google Play.
Docbook Enterprise offers a scalable and secure way for groups
and hospitals to meet a wide variety of workflow needs and enhance existing
technology systems. To bring the enterprise version of DocbookMD to your
hospital or large group, contact DocbookMD Director of Partnerships Chad Shepler
email or phone at (512) 383-5822.
Apply for the 2013-14 Texas Physician Practice Quality Improvement
Texas physician practices continue to make great strides in providing
reliable preventive services by using health information technology and
effective care management methods. These practices should be recognized for
their hard work.
Health Quality Institute, TMA, and the Texas Osteopathic Medical Association
have partnered again to provide the Texas Physician Practice Quality Improvement
Award program. Learn more about the award program and prepare to apply by
June 13. The online application will soon be available.
Four Reasons to Attend the Texas Health Home Summit
Join your colleagues for the second annual Texas Health Home Summit May 8-9 at the Westin Austin at The Domain to learn about medical home models
and best practices and to interact with experts at various stages of medical
home implementation. Register and access fee information online.
Presented by the Texas Medical Home Initiative and the Texas Health
Institute, the event will focus on integration of behavioral health into the
heath home and health homes for children and adolescents. TMA is a sponsor of
the event and a planning committee member.
Here are four reasons you should attend:
- Learn what your peers are doing to address the recently released National
Committee for Quality Assurance Patient-Centered Medical Home 2014 recognition
- Explore the challenges and opportunities of the Medicaid 1115 waivers.
- Attend a pre-summit presentation on integrating mental health into primary
care through medical and health homes like the Meadows Foundation's new Meadows
Mental Health Policy Institute.
- Attend a pre-summit session on how information technology can help you
achieve quality measures and medical home status.
The summit encompasses:
- An understanding of the medical home and how it promotes accessible,
continuous, and culturally effective health care.
- Awareness of best practices to improve the medical home for all types of
- Knowledge about how state and federal legislation impacts medical home
- Tools that can be used in the clinical practice or community to promote the
- A focus on consumer engagement and strengthened partnerships among families,
health professionals, and the health care system.
Albert C. Hergenroeder, MD, chief of Baylor College of Medicine's Adolescent
Medicine and Sports Medicine section, and Jennifer Markley, RN, TMF Health
Quality Institute's senior director for quality improvement, will headline a
session on care transitions.
Amy Gibson, chief operating officer of the Patient-Centered Primary Care
Collaborative in Washington, D.C., will address recent studies on the
effectiveness of the health home.
Continuing medical education credit information for the summit will be
announced soon. Email
Stephanie Ondrias with questions.
Take The Physicians Foundation's 2014 National Physician Survey
Let your voice be heard! Complete the 2014 National Physician Survey, sponsored by The Physicians
Foundation, a nonprofit organization that works to improve physician
satisfaction. The foundation's third national survey gives you and your
colleagues a chance to comment on the current state of the medical profession in
what may be the most comprehensive survey of American physicians ever
Your responses to the survey will help The Physicians Foundation provide a
state of the union of the medical profession to policymakers, political leaders,
and the public so that the physicians' perspective can command the attention it
And here's a bonus: When you take the survey and include your email address,
you'll be entered into a drawing for a $10,000 travel voucher, a $2,000 Apple
voucher, or an iPad Air. Plus, participants who provide an email address will
receive a copy of the full survey report.
This Month in Texas Medicine
The May issue of Texas Medicine encourages physicians and their staff
to continue preparing for ICD-10, despite the one-year implementation delay;
highlights a state pilot project aimed at streamlining care for dual-eligible
patients; introduces Texas' new medical school deans; tells the story of a
hospital and physicians who reached an agreement in a dispute over obstetric
privileges; and features the 2013 TMA Annual Report.
to launch the full edition in a new window.
Texas Medicine RSS Feed
Don't want to wait for Texas Medicine to land in your mailbox? You
can access it as an RSS feed, the
same way you get the TMA Practice E-Tips RSS feed.
E-Tips RSS Feed
TMA Practice E-Tips, a valuable source of hands-on,
use-it-now advice on coding, billing, payment, HIPAA compliance, office policies
and procedures, and practice marketing, is available as an RSS feed on
website. Once there, you can download an RSS reader, such as Feedreader,
Sharpreader, Sage, or NetNewsWire Lite. You also can subscribe to the RSS feeds
for TMA news releases and for Blogged Arteries, the feed for
This Just In ...
Want the latest and hottest news from TMA in a hurry? Then log on to Blogged
Deadlines for Doctors
TMA's Deadlines for Doctors alerts you and your staff to upcoming
state and federal compliance timelines and offers information on key health
policy issues that impact your practice.
Last Day For First-Year Participants to Begin the 90-day Reporting Period for
the 2014 Medicare EHR Incentive Program
The TMA Education Center offers convenient, one-stop access to the
continuing medical education Texas physicians need. TMA's practice management,
cancer, and physician health courses are now easier than ever to find
NPP Regulations: Rules You Need to Know
5/13 Houston 1
5/14 Houston 2
5/21 Corpus Christi
6/10 Wichita Falls
5/15 Live seminar webcast!
Can't make it to the seminar? Register for the live seminar webcast.
Dealing with Difficult
Making Discussions About Death and Dying
Meaningful Use: Information Technology
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