Rural Texas Physician

Spring 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


GME Boost, Tax Relief in Sight This Legislative Session

Graduate medical education (GME) expansion is TMA’s top priority this legislative session, and TMA leaders are pushing for increased state dollars to expand GME capacity. The House of Representatives voted last week to finalize its version of the 2016-17 state budget, and the Senate took action last week. Both chambers’ proposals add funding for GME, as well as women’s health care and mental health care services. 

GME and primary care workforce development stand to get a significant boost: The House bill adds roughly $24 million, and the Senate proposes an additional $62 million. It will be up to a conference committee to work out the differences. 

Meanwhile, Senate Bill 18 by Senate Finance Committee Chair Sen. Jane Nelson (R-Flower Mound) proposes a set of GME expansion programs that would put that budget money into action to reach a goal of 1.1 slots per medical school graduate. The Senate Finance Committee adopted a proposal for $41 million to implement the GME expansion provisions in SB 18 and an additional $19 million in support of primary care workforce development programs, including the Family Medicine Residency Program and Statewide Primary Care Preceptorship Program. 

TMA is monitoring the bill to make sure it addresses critical physician shortages across specialties without unnecessarily complicating the GME funding process. 

On the House side, an increase of 14 percent has been proposed for the state’s GME formula funding program, to take it from the current $70 million to $80 million in the 2016-17 biennium. These monies are intended to help offset training costs for residents. The Senate, at this writing, proposes $86 million for GME formula funding. The proposed budget includes $460 million in general revenue funds to restore Medicaid payments to Medicare levels for certain primary care physicians and providers. 

The House budget bill also adds to the Texas Department of State Health Services budget for programs in infectious disease prevention ($20 million), tobacco cessation ($10.7 million), primary care and women’s health care ($20 million), and neonatal drug abstinence ($17 million). 

However, leaders in the upper chamber stepped out first with their expected push for a tax relief package. Senator Nelson, Lt. Gov. Dan Patrick, and Sen. Charles Schwertner, MD (R-Georgetown), unveiled a proposal that contains $4.6 billion in property and franchise tax cuts and consists of three bills: Senate bills 1 and 7 by Senator Nelson and Senate Bill 8 by Senator Schwertner. A House proposal is not far behind. 

More relief for physicians could be on the way thanks to Sen. Kevin Eltife (R-Tyler), who filed Senate Bill 765 to eliminate the $200 annual occupation tax on physicians and other Texas professions. Physicians are subject to both the franchise tax and the occupation tax, and TMA maintains the double tax is not appropriate. 

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Federal Grant Program to Reduce Opioid Overdoses in Rural Areas

The Federal Office of Rural Health Policy (FORHP) recently announced the Rural Opioid Overdose Reversal Grant Program (ROOR), a one-year program that will fund efforts focused on preventing opioid overdose in rural areas.

The ROOR program aims to reduce the incidence of morbidity and mortality related to opioid overdoses in rural communities by purchasing naloxone and emergency devices used to reverse the effects of opioid overdoses rapidly. The program also will train licensed health care practitioners and emergency responders on the use of emergency devices. FORHP plans to award funding to up to 18 rural partnerships for one year for up to $100,000.

Eligible applicants include community partnerships composed of local emergency responders and other local nonprofit and for-profit entities involved in the prevention and treatment of opioid overdoses. The lead applicant organization must be located in a rural area or in a rural census tract of an urban county, and all services must be provided in a rural county or census tract. Determine rural eligibility here.

FORHP will hold a webinar that’s open to the public on Friday, April 24, at 1 pm (EDT) to help applicants. The toll-free call-in number is (877) 917-1550,and the passcode is 5276714. Access it online at

The deadline to apply for the ROOR program is June 8, 2015. For more information, contact Michele Gibson at or (301) 443-7320.  

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Save the Date for the Last First Tuesday of the 2015 Legislative Session

Save the date and register for the May 5 First Tuesday at the Capitol. 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 in the House and Senate galleries. It’s time again to bring out Texas medicine’s strongest weapon.  

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TMB Rules: Telemedicine Requires In-Person Exam First

On April 10, the Texas Medical Board (TMB) adopted strong new patient-protection rules regulating the practice of telemedicine. The board clarified its disciplinary guidelines in this regard. By voting to require physicians to conduct a face-to-face examination before making a diagnosis or prescribing drugs, TMB took a big step toward protecting patients who receive telemedicine services. 

TMB has been examining the practice of telemedicine for years and is involved in a lawsuit with Dallas-based company Teladoc. 

In a comment letter TMA sent to TMB on the proposed rules, the association states that it “supports the use of telemedicine that can provide safe, high-quality, timely care to patients, particularly in areas of the state that have critical physician shortages. However, TMA believes that Texas must maintain appropriate safeguards to protect patients and ensure telemedicine complements the efforts of local health care providers.” 

According to the rules, physicians can see a patient via telemedicine for the first time — without a prior in-person visit — if the patient is at a location that allows a physician to examine and communicate adequately with the patient in real time with the assistance of technology and a patient site presenter. The new telemedicine rules also permit mental health services to be provided at a patient’s home, including residential treatment facilities, nursing homes, jails, detention centers, and assisted living centers, through real-time audio and video technology. 

Despite claims to the contrary from critics, the changes do not and are not intended to interfere with traditional on-call coverage arrangements, based on the board’s discussion during its meeting April 9. 

Barring a court challenge and subject to any changes during the legislative session, the rules take effect June 3, 2015.  

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Register for the Third-Annual Health Home Summit

Registration is now open for the third-annual Primary Care and Texas Health Home Summit, set to take place June 18-19 in San Antonio at the Marriot Plaza Hotel. This year’s theme is Supporting the Quadruple Aim: The Triple Aim of High Value Patient Care and Provider Joy.

Register before May 29. 

The Summit will feature:  

  • Building a successful accountable care organization;
  • Emerging models of care, including direct primary care and “practices without walls”;
  • Value-based contracting and how practices can participate;
  • Implementation of the new Chronic Care Management Code for Medicare beneficiaries with multiple chronic condition;
  • Importance of comprehensive medication management and medication adherence to patient outcomes;
  • Successful models of integrating behavioral health into primary care; and
  • Successful Medicaid 1115 waiver health home projects.    

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Fund Your Vaccination Event: Apply for a TMA Grant

TMA can help you fund a local shot clinic. TMA’s Be Wise — ImmunizeSM offers grants of up to $2,500 to fund vaccination events for children, adolescents, or adults. 

TMA will accept applications until July 1, 2015, for its Be Wise Local Impact Grants. Physicians, medical students, TMA Alliance chapters, and county medical societies can apply for funds to support free or low-cost vaccination events. Any recommended vaccination qualifies. 

TMA actively works to improve vaccination rates in Texas through its Be Wise — Immunize program. More than 277,000 shots have been given to Texas children, adolescents, and adults since the program began in 2004. 

Since 2012, TMA has awarded more than $70,000 through the Local Impact Grants program to ensure Texans who are uninsured or underinsured, or who face other obstacles, receive needed vaccinations. 

To plan your free or low-cost vaccination event, check out the Be Wise — Immunize Quick Start Manual: A Step-by-Step Vaccination Outreach Guide. If you have questions, contact Tammy Wishard, TMA’s outreach coordinator, at (512) 370-1470. 

Be Wise — Immunize is a joint initiative led by TMA physicians and the TMA Alliance. Funding for Be Wise —Immunize is provided by the TMA Foundation thanks to generous support from H-E-B, TMF Health Quality Institute, and Permian Basin Youth Chavarim, along with gifts from physicians and their families. 

Be Wise — Immunize is a registered service mark of the Texas Medical Association.  

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Hard Hats for Little Heads: 200,000 Helmets and Counting

TMA’s Hard Hats for Little Heads bike helmet giveaway program has wheeled up to a milestone worth noting: giving away its 200,000th helmet. Let’s keep the momentum going by planning a helmet giveaway in your community. 

Hosting a Hard Hats for Little Heads’ event is easy and rewarding. TMA provides everything you need: helmets, event signage, promotional flyers, educational handouts, and media relations support. TMA encourages physicians, county medical societies, medical students, and TMA Alliance members to give free helmets to children in their community. 

TMA provides free helmets with your purchase of helmets. Buy 50 helmets at our cost of $7.60 each, and we’ll give you 50 helmets free. Take a look at where Hard Hats has been. If your county isn’t represented, put it on the map this year. 

Check out these ideas for events and start planning your event now. To find out more, contact Tammy Wishard, TMA outreach coordinator, at (512) 370-1470. 

Hard Hats for Little Heads is made possible through a grant from TMA Foundation thanks to top donors — Blue Cross and Blue Shield of Texas, Prudential, and two anonymous foundations — and gifts from physicians and their families.

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