Stories from Texas Medicine, December 2013

Driving Quality - 04/19/2018

Private payers aren't the only ones eyeing quality-based payment reform to control costs while improving patients' health. Now that Texas Medicaid has moved into managed care almost completely, the state is intent on similar strategies. The Texas Health and Human Services Commission won a $3 million federal grant to design innovative delivery and payment systems. It hopes to win as much as $50 million to later test the models under the Centers for Medicare & Medicaid Services State Innovation Models initiative. From accountable care organizations and medical homes to health information technology and bundled payments, the state is looking to physicians, health plans, and others to figure out what it takes to successfully implement such models for Medicaid patients across the multiple payers and providers that manage them.


Untested Waters - 04/17/2018

It got off to a really rough start, but the federal government launched the insurance marketplace under the Affordable Care Act (ACA) on Oct. 1. And physicians could encounter their own challenges if they are not vigilant in their business practices with the health plans in the marketplace that take effect Jan. 1, Texas Medical Association officials say. Topping the list is widespread physician uncertainty about whether having existing contracts with insurers means they're already included in an exchange network. Right after that is a federal rule that jeopardizes physician payments if patients with subsidized marketplace coverage don't pay their premiums. Exchange regulations give those patients three months to pay their premiums and allow health plans to deny or later recoup payments from doctors for services provided to patients who end up delinquent.


Peer Review Farce - 01/31/2018

TMA's policies on medical peer review promote a fair, reasonable system; the association condemns peer review abuses that harm physicians and have negative ramifications for patient care. Doctors subjected to unwarranted peer review action can sue. TMA came to the aid of locum tenens emergency physician Van Mask, MD, after he sued Coon Memorial Hospital in Dalhart, alleging officials published false and defamatory statements about him and falsely represented that he had quality and liability problems pursuant to a medical staff committee review. TMA argues in part that the hospital's ER/Trauma Committee didn't appear to be a medical peer review committee under Texas law. The case was settled before going to trial.


The Journal of Texas Medicine: December 2013 - 05/13/2016

Community service has a documented correlation with improved medical school performance. To promote community service and awareness of community resources, a Community Service Day was integrated into orientation for incoming first-year students at Baylor College of Medicine. One hundred seventy-five first-year medical students and 31 second-year leaders volunteered at 11 community sites. We hoped this early introduction to community service would make students more aware of community resources and motivate them to continue volunteering throughout their medical training. Students were surveyed about their experiences. Seventy percent of responding students reported the service day helped them learn about the community's resources related to health care, and 92% reported it helped them get to know their classmates. We concluded that integrating a Community Service Day into medical student orientation is a successful way to expose students to community resources, while simultaneously enco...


Pure Medicine - 05/13/2016

The culture of medicine has changed. Forthcoming ICD-10 codes, meaningful use requirements, and fee-for-service billing dominate medical-industry conversations. Patients are slowly being pushed to the side, replaced by political debates. And physicians are burning out from paperwork and administrative tasks. Some physicians become bitter, burned out, or tempted away from humanitarianism by high reimbursement rates. Over time, medical students lose their idealism, altruism, and empathy. The few oases of "pure" medicine are dwindling. Charitable clinics, which exist only to serve, are unaffected by the darker side of medicine that serves to turn a profit. Student-run clinics and more than 1,200 other charitable clinics around the nation serve patients regardless of income or insurance status.


Meaningful Deadlines - 05/13/2016

For physicians participating in Stage 1 or Stage 2 of the Medicare electronic health record (EHR) incentive program, Oct. 1, 2014, is the cutoff date for ensuring you've upgraded your EHRs to meet Stage 2 product certification requirements. If it's your first time to attest to meaningful use, you must begin the 90-day EHR reporting period by July 1, 2014, to meet the Oct. 1 deadline and avoid a future penalty. The software upgrade mandated by the U.S. Department of Health and Human Services Office of the National Coordinator for Health Information Technology requires you to collaborate with your EHR vendors. You'll also need time to test the system and train your staff on how to use it.


Bright Ideas - 05/13/2016

Texas medical schools are part of a movement to adapt medical education to today's evolving health care system. They are trying to get ahead of the curve with innovative approaches to meeting the current physician workforce demands, such as reducing medical school from four to three years.