Rural Texas Physician

Winter 2015

Rural Texas Physician is a quarterly electronic newsletter catering to physicians in the many rural areas of Texas caring for patients and their communities. TMA’s grassroots membership is the strength of the association. For general inquiries or newsletter comments, email rural@texmed.org.

Feds Reduce Meaningful Use Reporting Burden to 90 Days in 2015

Responding to pressure from TMA and organized medicine, the Centers for Medicare & Medicaid Services announced yesterday it plans to modify rules for the Electronic Health Record Incentive Programs to reduce the reporting burden on physicians. Expected to be released this spring, the modified rules will include: 

  • Shortening the 2015 reporting period from a full year to 90 days,
  • Realigning hospital reporting periods to the calendar year to allow eligible hospitals more time to incorporate 2014 Edition software into their workflows and to better align with other quality programs,
  • Modifying other aspects of the programs to match long-term goals, reduce complexity, and lessen providers’ reporting burden.  

CMS noted that these modified rules are separate from the forthcoming Stage 3 proposed rule set for a March release in which the agency intends to limit the scope of the Stage 3 proposed rule to the requirements and criteria for meaningful use in 2017 and subsequent years.  

In a blog announcing the modifications, CMS’ deputy administrator Patrick Conway, MD, said the changes are the agency's response "to provider concerns about software implementation, information exchange readiness, and other related concerns in 2015." 

"We are working on multiple tracks right now to realign the program to reflect the progress toward program goals and be responsive to stakeholder input," Dr. Conway said. See the CMS website for more information on the EHR Incentive Program. 

Visit TMA's EHR Incentive Resource Center for comprehensive information and education opportunities to help you thrive in the Meaningful Use landscape. If you have questions about the timelines and the EHR incentive program, contact TMA's Health Information Technology Department by calling (800) 880-5720 or by email.

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Texas Achieves Record Success in Attracting New Physicians

When the state fiscal year ended Aug. 31, 2014, the Texas Medical Board reached yet a new record for the annual total of newly licensed physicians, demonstrating the success of TMA-backed tort reform legislation adopted in 2003. Texas has averaged an annual increase of 3,255 newly licensed physicians in the 11 years since that tort reform, which is 38.6 percent higher than the average annual increase of 2,348 physicians in the 11 years prior to tort reform. 

Close to 4,000 physicians received their first Texas medical license in Fiscal Year 2014 – the highest ever for the state. This is an increase of 10 percent over the prior peak of 3,630 reached in 2012. The new peak is 11 percent over the past year when 3,594 were licensed, as shown in the graph. 

 

Newly Licensed Winter 2015

Source: Texas Medical Board Prepared by: Texas Medical Association

 

The number of medical license applications also reached a new historical peak, exceeding 5,000 for the first time. This is a jump of 11.7 percent over the previous peak reached last year. The board reported all-time record monthly levels for 11 months of FY 2014. 

Information on medical school of graduation is not yet available for these new physicians, but in recent years more than 70 percent were graduates of medical schools outside of Texas. This indicates Texas has a solid record of recruiting physicians from other states and countries. 

Despite these high numbers, Texas continues to rank 43rd in a state comparison of the ratio of physicians per capita, as reported by American Medical Association. Shortages persist in the state, and there is a need for continued recruitment from outside Texas as well as the education and training of new physicians at Texas programs.   

Applications Winter 2015

 

Applications have exceeded 4,000 for the past nine years. 

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Speedier Multi-State Licensure Gains Ground

Physicians who want to practice in more than one state could soon face fewer state licensure hurdles with the American Medical Association's recent support of a special interstate compact developed by the Federation of State Medical Boards. The compact's components, including the creation of an Interstate Medical Licensure Commission, are outlined in FSMB's model legislation

Among states that adopt it, the compact would act as an independent law and as a contract between states to help ensure ongoing corporation and adaptation

Created to make it easier for physicians to obtain licenses in multiple states while providing access to safe, quality care, the compact is expected to increase access to care for patients in rural and other underserved populations via the responsible practice of telemedicine. 

AMA's House of Delegates adopted new policy at its Nov. 2014 Interim Meeting to work with interested medical associations, the FSMB and other stakeholders to ensure the compact's expeditious adoption.

The compact is based on several key principles, including: 

  • The practice of medicine is defined as taking place where the patient receives care, requiring the physician to be licensed in that state and under the jurisdiction of that state’s medical board. This tenant aligns with the principles for telemedicine the AMA adopted last year. 
  • Regulatory authority will remain with the participating state medical boards, rather than being delegated to an entity that would administer the compact.
  • Participation in the compact is voluntary for both physicians and state boards of medicine. 

While the Texas Medical Board endorsed the concept for an interstate compact last May, its implementation would require changing state legislation. TMA will be watching for and monitoring bills on the compact this legislative session.

Additional compact details: 

  • Adoption of the model legislation by states is entirely voluntary and participation by individual physicians will likewise be voluntary in states where it is adopted. The compact states would be connected through a newly developed commission, however states do not cede sovereign rights to the commission. 
  • The model legislation sets a high bar for eligibility for licensure through the compact pathway and eliminates duplicative primary source verification requirements. An informal estimate from TMB indicates 70-75 percent of Texas physicians are expected to qualify. 
  • The new AMA policy is based on the concept that medicine is defined as taking place where the patient receives care, not the physician’s location. The physician is to be licensed in the state where the patient is located and the physician is under the jurisdiction of that state’s medical board.
  • Compact licensure pathway would be an add-on, not a replacement of the state medical licensing process, which would remain 100 percent intact. 
  • Regulatory authority remains with individual state medical boards. Physicians with licenses in multiple states through the compact would designate a specific state for their principal license. They would be subject to laws and licensing regulations for each individual state for which they have a license. This includes passage of applicable state jurisprudence exams and completion of mandatory continuing medical education (CME) credits. Each state retains their regulatory duties, including enforcement responsibilities.  

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Save 20 Percent on All Online CME This Month Only

TMA members already receive exclusive member pricing on all TMA continuing medical education courses as membership benefit, but for the entire month of January, the discounts have gotten even bigger—20 percent bigger! 

The TMA Education Center offers more than 80 CME courses covering a wide variety of topics, including some 50 offering ethics credit, making it easy to find education that can benefit you and your practice. 

Visit the TMA Education Center now and use coupon code NEWYEAR20 to receive an additional 20 percent off your entire TMA Education Center purchase. This exciting offer applies only to current TMA members and their staff and excludes live programs. 

For questions or more information about TMA seminars, contact the TMA Knowledge Center. Call (800) 880-7955 from 8:18 am to 5:15 pm CT or email

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Maintain a Healthy Practice With TMA's Help

If you’re one of the nearly 70 percent of Texas physicians experiencing declining revenues, increased expenses, or overwhelming administrative burdens, you may not have the time or resources, or a concrete plan, to take the next step in ensuring your practice’s vitality.

If you don’t know where to start, TMA Practice Consulting can help. TMA’s consultants can determine your practice’s current financial status and make projections using key performance indicators, and provide customized solutions. 

Why Choose TMA Practice Consulting? TMA's consulting team has been a trusted resource for Texas physicians and practices for more than 15 years, and these experts can help you, too. With several new services designed to let you know where your practice stands, the consulting team can provide support no matter what your stage in medical practice. Contact a TMA consultant today for your free consultation by calling (800) 523-8776 or emailing practice.consulting@texmed.org.

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Don't Go Blindly Into Your EHR Contract; Consider a Review

While 68 percent of Texas physicians already use an electronic health record of some kind, according to a TMA survey, a decent number of practices either haven't purchased an EHR system or want to replace the one they have.

As physicians review demonstrations and hear about the latest and greatest from EHR salespeople, it is the contract that seals the deal and defines the future relationship. A good contract review cannot be stressed enough. Seek the guidance of your attorney or someone who is savvy about EHR contracts. 

Paying for a contract review may be worthwhile because:  

  • There may be hidden fees not disclosed during the negotiations but spelled out in the contract; 
  • You need an exit strategy in case the relationship sours beyond repair; and
  • The contract should include terms defining how you get your data should you sever the relationship. 

With these issues in mind, TMA developed a helpful document, EHR Buyer Beware: Issues to Consider When Contracting with EHR Vendors, featuring eight must-haves for physicians. The Office of the National Coordinator (ONC) for Health Information Technology made available another source, EHR Contracts: Key Contract Terms for Users to Understand. The 25-page document is more inclusive and covers key information, such as details about a meaningful use warranty. 

You can direct questions about EHRs and other office technologies to TMA's Health Information Technology Department by calling (800) 880-5720 or by email.  

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New Physician Reentry, Mini-Residency Program Starts Next Month

The Texas A&M Health Science Center KSTAR Physician Assessment Program is partnering with The University of Texas Medical Branch at Galveston (UTMB) to create the KSTAR/UTMB Health Mini-Residency Program, whose first trainees begin next month. The mini-residency provides three-month, residency-based reentry education for physicians who want to return to medical practice after an interruption in their careers.

The components of this model of reentry education are: 

 

  • All training occurs within residency programs accredited by the Accreditation Council for Graduate Medical Education (ACGME).
  • Faculty represent seasoned clinicians and educators familiar with and supportive of physician reintegration into medical practice.
  • Reentry physicians work as part of a health care team and get hands-on experience, including access to performing procedures.
  • Physicians in the mini-residency interact with many specialties and subspecialties while they train.
  • The curriculum addresses aspects of all six core competencies, and the evaluation process focuses on achievement of curricular milestones.
  • Physicians trained in the program have access to educational experiences, such as lectures, presentations, and grand rounds, while they are getting clinical experience.
  • Most training occurs in medical settings.  

 

KSTAR has experience with residency-based reentry education, and UTMB has experience in reentry education within its post-graduate programs. KSTAR and UTMB have significant simulation resources available to enhance the program’s assessment and education components. TMB has the authority to grant KSTAR/UTMB trainees Visiting Physician Temporary Permits for out-of-state physicians or for those who do not currently hold an active medical license.

Liability coverage has been secured at a reasonable rate for KSTAR/UTMB trainees.

For more information visit www.rchitexas.org.

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GME Expansion a Top Priority for Texas Medical Specialty Societies

Winning greater investment in graduate medical education (GME) programs is a 2015 legislative priority for most of the Texas family of medicine.

Standing up before their peers at the 2015 TMA Advocacy Retreat, seven state specialty societies joined TMA and the Texas Osteopathic Medical Association in calling on state lawmakers to expand the number of residency slots Texas training institutions can support. They spoke not only of the need to grow Texas’ physician workforce, but also of Texas’ inability to further train the growing number of graduates from the state’s medical schools.

Most organizations at the retreat endorsed greater GME funding; those with specific suggestions included: 

  • Texas Academy of Family Physicians,
  • Texas Chapter of the American College of Physicians,
  • Texas Ophthalmological Association,
  • Texas Pediatric Society,
  • Texas Society of Anesthesiologists, 
  • Texas Society for Gastroenterology and Endoscopy, and 
  • Texas Society of Psychiatric Physicians.  

GME expansion is TMA’s first legislative priority for 2015, as presented in TMA’s Healthy Vision 2020, Second Edition, the association’s advocacy plan for the remainder of the decade: “To meet future physician demands, Texas needs a stable, high-quality medical education system to produce homegrown physicians. We must provide a reasonable opportunity for Texas medical school graduates to obtain their residency training in the state without being forced to leave home. Studies confirm physicians who complete medical school and residency training in the state are three times more likely to practice here.” Read all of Healthy Vision 2020 online.

Speaking at the Advocacy Retreat’s closing luncheon, State Rep. John Zerwas, MD (R-Simonton), who has been a key figure in drafting the past several state budgets, said physicians could realistically expect lawmakers to continue the GME expansion trend they began in the 2013 legislative session. They will find more money for GME, Representative Zerwas said, if physicians speak out about it loudly enough.

Twitter conversations during the retreat verified his prediction, as lawmakers from both sides of the aisle weighed in for more GME spending. State Rep. Donna Howard (D-Austin) called it “a priority for many of us in the Texas Legislature.” That brought an “Agree!” tweet from State Rep. Jeff Leach (R-Plano), who then added, “It’s a problem that so many Texas-educated docs are doing residencies and practicing medicine outside of Texas. Let’s fix it.”

Among other legislative priorities were:   

  • Stopping inappropriate expansion of the scope of practice of nonphysician practitioners,
  • Increasing state Medicaid payments and extending Medicare parity for Medicaid payments for primary care services,
  • Stopping the spread of health insurance narrow networks and protecting out-of-network physicians,
  • Regaining state funding support for several primary care preceptorship programs for medical students, and
  • Protecting Texas’ 2003 medical liability reforms.   

Several other specialty societies expressed their frustration with new federal regulations that reclassify drugs containing hydrocodone combinations from Schedule III to Schedule II. They asked Texas lawmakers to investigate what steps the state can take to ease the paperwork requirements associated with the reclassification.

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Medicaid Managed Care Expands to Nursing Home Patients

On March 1, some 50,000 to 60,000 nursing home patients on Medicaid will transition to STAR+PLUS, one of Medicaid's managed care plans, which will cover their basic health and long-term care services. The move is mandatory for patients over the age of 21 who meet STAR+PLUS criteria.

Duel eligible nursing home patients – those enrolled in both Medicaid and Medicare – will continue to receive their basic health services through Medicare, but their long-term care services will switch to STAR+PLUS.

For more information go to HHSC's webpage or view this HHSC summary.

HHSC physician and provider training on STAR+PLUS's expansion to nursing facilities:

Feb. 24
2- 4:30 pm

Register online.

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Save the Date for First Tuesdays

First Tuesdays at the Capitol returns and the Family of Medicine needs you! The "White Coat Invasion" has been the key to physicians' successes in the Texas Legislature since the inception of First Tuesdays at the Capitol in 2003. Our senators and representatives listen when their hometown doctors appear in their offices. Our influence is so much greater when physicians and alliance members arrive en masse in the House and Senate galleries. It's time again to bring out Texas medicine's strongest weapon.

Mark your calendar for the 2015 First Tuesdays at the Capitol, and register today: 

  • Feb. 3,
  • March 3,
  • April 7, and
  • May 5. 

Register today for one, two, or all four of the First Tuesday dates, and make your travel arrangements.

Although the Texas Legislature is becoming more hyper-partisan and hyper-political, TMA will continue to work for what's best for patients and their physicians. Medicine's 2015 legislative agenda, based on TMA's Healthy Vision 2020, Second Edition, will focus on: 

  • Increasing funding for graduate medical education.
  • Improving physicians' Medicaid and CHIP payments to more appropriately reflect the services they provide to patients.
  • Holding health insurance companies accountable for creating and promoting adequate physician networks.
  • Devising and enacting a system for providing health care to low-income Texans that improves efficiencies by reducing bureaucracy and paperwork.
  • Stopping any efforts to expand scope of practice beyond that safely permitted by nonphysician practitioners' education, training, and skills.
  • Promoting government efficiency and accountability by reducing Medicaid red tape.
  • Protecting physicians' ability to charge for their services.
  • Improving the state's public health defense to better respond in a crisis.
  • Preserving Texas' landmark medical liability reforms. 

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