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 firstname.lastname@example.org.
Texas Vaccines for Children Program Update
As of Oct. 1, the Texas Vaccines for Children program implemented changes to comply with federal requirements for ordering, storing, and shipping vaccines. This memo (PDF) from the Texas Department of State Health Services outlines the changes.
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Referral Guidelines for Primary Care Physicians
Patients in rural areas often face more barriers to receiving specialty care and rely on you to make appropriate referrals. Texas Health Steps provides free, online CME courses covering pediatric referral guidelines.
Texas Health Steps courses detail the health care professional’s role in the referral decision process, health plan requirements for specialty referral, and signs and symptoms that suggest immediate referral. Specific referral course topics include:
- Atopic Dermatitis
- Exercise-Induced Dyspnea
- Gastroesophageal Reflux in Infants
- High Blood Pressure, Pediatric Chest Pain
- Pediatric Depression
- Pediatric Hematology
- Pediatric Murmurs
- Referral Guidelines Overview
More than 40 CME course are approved by nine accrediting bodies, including TMA, the American Nurses Credentialing Center, National Commission for Health Education Credentialing, and Texas State Board of Social Worker Examiners. Select courses are approved by additional accrediting bodies.
To view the complete course listing and register for a free CME course, visit www.texashealthsteps.com.
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Rural Health Open Door Forum
The Rural Health Open Door Forum, sponsored by the Centers for Medicare & Medicaid Services (CMS), addresses rural health clinic (RHC), community access hospital (CAH), and federally qualified health center (FQHC) issues. It also includes other questions and concerns that occur in clinical practice pertaining to other CMS payment systems that extend into these settings. For more information, visit the CMS web site.
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Do EHR Mandates Exist?
It depends. What is your definition of a mandate? You do not have to use an electronic health record (EHR) in your practice, but if you don't, you will face Medicare penalties beginning in 2015.
Currently, Medicare is the only payer planning to penalize physicians who are not "meaningfully using" their EHR system. That's right, meaningful use is required to prevent the penalty. The penalties begin at 1 percent in 2015 and tentatively will cap at 3 percent in 2017. If at least 75 percent of office-based physicians are not meaningfully using an EHR by 2017, the U.S. Department of Health and Human Services secretary has the authority to ratchet the penalty by 2 more percentage points, capping the penalty at 5 percent in 2019.
TMA has created a one-page explanation that charts the penalties for both scenarios and provides information on penalty exemptions.
To prevent the penalty, you must start your meaningful use reporting period by July 1, 2014. The federally established regional extension centers (RECs) are ready to help you with EHR selection, adoption, and meaningful use. For more information, visit the Texas Regional Extension Center Resource Center on the TMA website.
Direct your 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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Two EHR Monitors Better Than One
Physicians using electronic health records (EHRs) may consider using two computer monitors. It's an inexpensive way to enhance the workflow and allow viewing of multiple EHR pages or documents from other sources. Time is of the essence during a patient visit, and EHRs may hurt productivity. The second monitor may help physicians during patient visits.
Consider the second screen for ease of viewing:
- Immunization data from ImmTrac,
- Patient information from the local health information exchange,
- Consultant's note(s) about the patient,
- Recent lab results via the lab portal, and
- Health information on a website.
The cost of a second monitor would range from about $150 to $400, depending on size and resolution. Most new computers have ports to accommodate multiple screens; if not, a simple splitter will suffice. While a second screen may seem overwhelming initially, many users quickly adjust and appreciate the ability to multitask efficiently.
Physicians needing assistance with EHRs may consider using one of the four Texas regional extension centers (RECs). Details about the program are available in the TMA REC Resource Center.
For more information about the electronic health record incentive program or other health information technology issues, contact TMA's HIT Department by phone at (800) 880-5720 or by email.
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Ethics CMS Available Through Texas Health Steps
Are you obligated to disclose a 16-year-old's medical records to her parent? Is it your responsibility to make accommodations in your office for non-English-speaking patients?
As a physician, you may face tough ethical questions like these in your practice every day. It's important to comply with legal requirements while maintaining a healthy relationship with your patient. Texas Health Steps offers free, online continuing medical education (CME) courses that provide professional guidelines to help you navigate ethical dilemmas that may arise in your practice. The following courses are accredited for ethics CME:
- Teen consent and confidentiality;
- Motivational interviewing;
- Cultural competence;
- Recognizing, reporting, and preventing child abuse; and
- Screening, brief intervention, and referral to treatment (tutorial).
All Texas Health Steps courses are free and available for health care professionals 24/7. More than 40 courses include topics like adolescent health, prevention and wellness, and pediatric referral guidelines. All courses are accredited by TMA, the American Nurses Credentialing Center, National Commission for Health Education Credentialing, and Texas State Board of Social Worker Examiners. Select courses are approved by additional accrediting bodies.
To learn more and register for an online course, visit www.texashealthsteps.com.
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