Action: April 15, 2014

 TMA Action April 15, 2014   News and Insights from Texas Medical Association

INSIDE: DPS Begins to Synch Controlled Substance Permit Renewals 

DPS Begins to Synch Controlled Substance Permit Renewals
Be Careful With Covenants Not to Compete
New HIPAA Security Risk Tool From HHS
FTC Calls for APRN Independent Practice
Take The Physicians Foundation's 2014 National Physician Survey 

Physician Cyclists: Share Your Passion With Local Kids
Register for the Texas Health Home Summit Today
Access DocbookMD on Your Computer
This Month in Texas Medicine

DPS Begins to Synch Controlled Substance Permit Renewals

Following a three-month delay, the Texas Department of Public Safety (DPS) reports it is beginning to synchronize physicians' controlled substances registration (CSR) expiration dates with their Texas Medical Board (TMB) license expiration dates.

On Jan. 1, renewal of CSR permits issued by DPS should have become part of physicians' biennial online medical license renewal with TMB. TMA helped pass House Bill 1803 by Rep. Bill Callegari (R-Katy) and Sen. Joan Huffman (R-Houston) to ease the administrative hassle and red tape on physicians when they renew their CSR permits and to avoid interruptions in patient care and in physicians' practices due to inadvertent expirations.

TMB had completed the work necessary to implement HB 1803 by Jan. 1, including developing data-sharing capabilities that allow information to flow electronically to DPS for processing. In February, however, DPS said it wasn't prepared. 

Under the law, permits valid on Jan. 1, 2014, would automatically extend to the date of the physician's next state medical license renewal. At that time, the CSR permit would be valid for two years for a $50 fee. 

To ensure you do not experience disruption in your prescribing authority or place medical staff privileges at risk, DPS has posted the following information on its Controlled Substances Search and Verification System website for physicians with CSRs set to expire in April:

  • If your TMB license expiration date is May 31, 2014, or Aug. 31, 2014, CSRs have been automatically renewed to expire April 30, 2015. The next certificate you receive will be synchronized with your TMB license expiration date.
  • All remaining registrations scheduled to expire in April have been synchronized with the TMB expiration date. 
  • No action is required by the physician. Affected physicians will receive new CSR certificates in the mail.   
  • New CSR expirations have been updated on the Controlled Substances Search and Verification System website.

In the past, physicians have had problems when DPS didn't process renewals in a timely manner, before the CSR permit's expiration. When physicians are unable to renew their CSR permits, they can't prescribe medications. A physician's ability to prescribe medications hinges on possession of a valid CSR, which is necessary to obtain a permit from the Drug Enforcement Administration.

Just as critical, a physician whose CSR permit lapses faces (at least) temporary suspension of hospital privileges, as maintaining current certifications is a requirement to retain medical staff privileges in Texas

TMA has been meeting with DPS officials and TMB representatives to address concerns among physicians and to ensure DPS would be prepared to allow for the two-year permit and to synchronize the expiration of the CSR with the physician's medical license renewal date. 

Visit the Regulatory Services Division webpage for updates and additional information about synchronization of CSRs that expire in the future.

Be Careful With Covenants Not to Compete

Almost every contract has an escape hatch — but you might have to escape to a place you don't want to be.

Most physician employment contracts, and many health plan contracts, have provisions known as covenants not to compete, or noncompete clauses, which prevent you from competing with your former employer if you decide to leave and open a practice somewhere else. 

Sometimes they go too far. Texas law says noncompete clauses are enforceable if they contain reasonable limits on when, where, and how a physician can establish a new practice. The TMA Board of Councilors says, "Restrictive covenants are unethical if they are excessive in geographic scope or duration in the circumstances presented, or if they fail to make reasonable accommodation of a patient's choice of physician."

Physicians can negotiate the terms of a noncompete clause before they sign a contract, and Texas says that for a covenant not to compete relating to a performance of medical services to be enforceable, it must — among other things — include a buy-out clause.

Check out these TMA resources for more details:


New HIPAA Security Risk Tool From HHS

The U.S. Department of Health and Human Services (HHS) released a new HIPAA compliance tool for small- to medium-sized practices. 

The Security Risk Assessment (SRA) tool helps these practices conduct and document a risk assessment to determine potential HIPAA security risks and address them. The SRA website has user tutorials and videos available to help you get started.

Conducting a security risk assessment is a key requirement of the HIPAA Security Rule and a core requirement for physicians participating in the Medicare and Medicaid electronic health record (EHR) incentive programs. The SRA tool also allows practices to print a report that can be provided to auditors. 

If you need more in-depth assistance, the Texas regional extension centers (RECs) can help with EHR selection, workflow optimization with the EHR system, meeting meaningful use measures (including the security risk assessment), and attesting to meaningful use to receive the incentives. 

For more information about the Texas RECs, check out TMA's REC Resource Center. Our REC locator tool can help you determine which REC serves your area. 

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

     TMLT Action Ad 4.13

FTC Calls for APRN Independent Practice

In a new report, the Federal Trade Commission (FTC) encourages states to allow a wider scope of practice for nurses with postgraduate education and urges state lawmakers to loosen regulations on advanced practice registered nurses (APRNs), allowing them to deliver care independently of physicians. The FTC claims more independent APRNs will increase competition in the primary health care marketplace.

TMA policy acknowledges the importance of APRNs to the current health care system. TMA strongly supports current Texas law that requires APRNs to maintain clinical linkages to physicians through integrated practice.

TMA opposes independent delivery of health care by nurses. Nurses should, however, be encouraged to obtain advanced education and training. The policy states the nurse with such training: 

  • Engages in decisionmaking about the nursing care of patients under the supervision of a physician; 
  • Collaborates with social workers, nutritionists, and others in making decisions about nursing needs; 
  • Plans and institutes nursing programs as a member of the health care team; and 
  • Is directly accountable and responsible to the patient for the quality of nursing care rendered under the Nurse Practice Act of Texas. 

In the report, the FTC states physician supervision requirements for APRNs may deny consumers the benefit of greater competition by giving one group of health care professionals the ability to restrict access to a competing group of health care professionals. APRNs play a vital role in compensating for primary care physician shortages and expanding access to care for underserved populations, the FTC says.

The FTC argues additional supervision requirements could hinder APRNs' collaborative, consulting, or referral-based relationships with primary care doctors, specialty physicians, and other health care professionals and impair the development of new models of health care.

"Effective collaboration between APRNs and physicians does not necessarily require any physician supervision, much less any particular model of physician supervision," the FTC says.

The FTC's move stems from an October 2010 Institute of Medicine (IOM) report that asserts access to care can be expanded by increasing the use of APRNs in primary, chronic, and transitional care. The report also contends scope-of-practice restrictions undermine the nursing profession's ability to provide and improve general and advanced care. 

In the report, IOM calls upon the FTC and the Antitrust Division of the U.S. Department of Justice to pay continued attention to the competition issues raised by scope-of-practice regulations. 

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 undertaken.

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 deserves.

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. 

TMAIT Action Ad 4.13   

Physician Cyclists: Share Your Passion With Local Kids

If you're a cyclist, TMA's Hard Hats for Little Heads bike helmet giveaway program is a perfect way to share your passion for fitness and safety. TMA is sprinting toward a huge goal this year — to give 34,000 Texas children a new helmet — in celebration of Hard Hats' 20th birthday. 

We need your help to pick up the pace. Put the wheels in motion today to sponsor a helmet giveaway anytime in 2014 or during these key times: 

  • May — Bike Month.
  • October during TMA's statewide helmet blitz.
  • During the holidays in conjunction with a bike giveaway.  

Hosting a Hard Hats for Little Heads event is easy. TMA provides everything you need: free helmets, banners, event signage, promotional flyers, educational handouts, and media relations support. When you buy 50 helmets, TMA will match your purchase with another 50 free helmets. Helmets are $7.35 each, including shipping.

Join with your cycling club, county medical society, or community organization (school, fire department, civic club, etc.) for your helmet giveaway. Find event ideas and more in the Hard Hats event toolkit. Email TMA's outreach coordinator or call (800) 880-1300, ext. 1470, or (512) 370-1470 to learn how to host an event.

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

Register for the Texas Health Home Summit Today

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 health home and on health homes for children and adolescents. TMA is a sponsor of the event and a planning committee member.

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 patients.
  • Knowledge about how state and federal legislation impacts medical home implementation.
  • Tools that can be used in the clinical practice or community to promote the medical home.
  • A focus on consumer engagement and strengthened partnerships between families, health professionals, and the health care system. 

Continuing medical education credit information for the summit will be announced soon.

  PC Action Ad Sept 13    

Access DocbookMD on Your Computer

DocbookMD has always been a valuable tool on iOS and Android platforms, allowing physicians and their staff to communicate securely from their mobile phones and tablets. Now Docbook Enterprise members can access DocbookMD on their desktop or laptop computers, an option that limits staff use of cellphones while allowing them to connect with you to coordinate patient care.

Mobile communication is still at the core of what DocbookMD offers, but the new web version gives hospitals and groups the added flexibility of a communication tool that does not require a smartphone or tablet.

Docbook Enterprise is an affordable, customizable communication solution for groups and hospitals that leverages the same platform that medical societies have relied on for years. With Docbook Enterprise, any physician or staff member can access the hospital directory, send and receive secure messages, and share images and reports at the point of care.

DocbookMD is a free member benefit, available in Texas only to TMA members.\

This Month in Texas Medicine 


The April issue of Texas Medicine examines how Texas practices are coping with challenges brought about by the Affordable Care Act, new rules that overhaul residency training accreditation, the impact of patient noncompliance on quality outcomes and physician ratings, the challenges physicians face in giving the HPV vaccine, new DocbookMD features, and a profile of the TexMed 2014 General Session speaker, Zubin Damania, MD.

Check out our digital edition.  

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 the TMA 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 Action.  

This Just In ...

Want the latest and hottest news from TMA in a hurry? Then log on to  Blogged Arteries.    

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.  


HIT: Last Day For First-Year Participants to Begin the 90-day Reporting Period for the 2014 Medicare EHR Incentive Program  

TMA Education Center 

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 online. 


ICD-10 Documentation and Auditing 
4/16       Beaumont

New NPP Regulations: Rules You Need to Know
5/7      San Antonio
5/13     Houston 1
5/14     Houston 2
5/15     Austin
5/20     McAllen
5/21     Corpus Christi
6/4       El Paso
6/10     Wichita Falls
6/11     Lubbock
6/17     Fort Worth
6/18     Dallas
6/19     Tyler

5/15     Live seminar webcast! Can't make it to the seminar? Register for the live seminar webcast.

On-Demand Webinars

Dealing with Difficult Patients 
Making Discussions About Death and Dying Easier 
Meaningful Use: Information Technology Bundle  


5/2-3    Fort Worth 

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Last Updated On

November 09, 2017