Action: May 2, 2014

 TMA Action May 2, 2014   News and Insights from Texas Medical Association

INSIDE: TMA Urges Congress to Extend CHIP Funding Beyond 2015  

TMA Urges Congress to Extend CHIP Funding Beyond 2015
TMA Opposes Proposed Overreaching Agency Rules
Brush Up on NPP Regs With New TMA Seminar
Stage 2 Meaningful Use Incentive Calculator Now Available
Law Sheds Light on Industry Payments to Physicians
Umbilical Cord Blood Banking
Physicians Help Create a Healthy Economy
File Your Franchise Tax Reports by May 15

DSHS Offers Newborn Screening Requirement Guidance
Memorial Hermann, DocbookMD Deal Connects Houston Physicians
Apply for the 2013-14 Texas Physician Practice Quality Improvement Award
Four Reasons to Attend the Texas Health Home Summit
Take The Physicians Foundation's 2014 National Physician Survey
This Month in Texas Medicine

TMA Urges Congress to Extend CHIP Funding Beyond 2015

TMA signed onto a March of Dimes and Texas Pediatric Society letter asking Gov. Rick Perry to urge the Texas congressional delegation to support continued Children's Health Insurance Program (CHIP) funding beyond 2015. Though the program will run through 2019, federal funding for CHIP expires Oct. 1, 2015, unless Congress extends it.

"Thanks to leaders like you, between 84-87 percent of children in Texas were insured in 2012 — a record high. Texas CHIP is a major part of this success story, providing health coverage to over half a million Texas children each month for a total of 999,838 Texas children served (in 2012)," the letter states.

Since CHIP's inception in 1997, it has halved the number of low-income, uninsured children nationwide — from 25 percent in 1997 to 13 percent in 2012 — and has improved health outcomes and access to care for children and pregnant women, TMA and dozens of other organizations that signed the letter told the governor. 

Texas CHIP also provides women with prenatal health care and preventive services during pregnancy.

"If Congress doesn't act, more than 7.8 million children nationwide — more than 50 percent of those insured by CHIP — would lose their coverage by 2016. Likewise, pregnant women enrolled in CHIP could be left without other sources of prenatal care, jeopardizing the health of their newborns. We fear that, without CHIP, our state's uninsured rate would increase significantly and the health of children and families in Texas would be in jeopardy," the letter concludes.

TMA Opposes Proposed Overreaching Agency Rules

TMA President Stephen L. Brotherton, MD, wrote formal comment letters for the association opposing two state agencies' proposed rules that go too far.

TMA and the Texas Neurological Society wrote a formal letter opposing a Texas State Board of Dental Examiners' (TSBDE's) proposal to allow dentists to diagnose and treat sleep apnea. 

"If a dentist practices outside the scope of dentistry, such as diagnosing or independently treating a sleep disorder, he or she is, by definition, practicing medicine unlawfully," Dr. Brotherton wrote. "It is imperative that diagnoses of the presence or the absence of sleep disorders, including but not limited to benign snoring and sleep apnea, be made by a qualified Texas-licensed physician, in order to protect the health and safety of Texas' patients."

In the letter, TMA cites a 2012 joint policy issued by the American Academy of Sleep Medicine (AASM) and the American Academy of Dental Sleep Medicine (AADSM). The policy asserts, "The evaluation and diagnosis of sleep apnea must be made by a physician, and therapies for sleep apnea, including positive airway pressure and oral appliance therapy, must be prescribed by a qualified physician."

The letter concludes: "The rules as proposed would be in violation of the Texas Medical Practice Act and the Texas Dental Practice Act. We urge the TSBDE to consider these comments and modify its proposed rules as recommended in this letter, in conformity with the Texas Dental Practice Act, the Texas Medical Practice Act, and the policy statements of the Texas Medical Board (TMB), AASM, and AADSM."

Also, TMA wrote a letter to oppose a TMB rule that would require the supervisor of a physician assistant temporary license holder to not only be a Texas-licensed physician with an unrestricted license but also not to have been the subject of a disciplinary order, other than one administrative in nature. 

"A Texas-licensed physician who holds an unrestricted medical license is, by the TMB's own assessment, authorized to perform any medical service or procedure that falls within the scope of his or her license in the state of Texas," Dr. Brotherton wrote. "Thus, he or she should be capable of providing 'adequate supervision' of a physician assistant temporary license holder. The fact that a physician once, perhaps many years ago, had a disciplinary order does not change this assessment."

The letter states that "establishing a requirement that the supervisor must have never been the subject of a disciplinary order is not the appropriate way to measure the physician's current basic competency." 

TMA urges the medical board not to adopt the proposed amendment and adds, "Should the TMB choose to move forward with its proposal over TMA's objection, TMA recommends that the TMB, at a minimum, limit the rule's language regarding ineligibility based upon the supervisory physician's past disciplinary order to disciplinary orders that occurred within the past year."

Brush Up on NPP Regs With New TMA Seminar

With input from TMA, the 2013 Texas Legislature simplified the process by which physicians supervise and delegate to nonphysician practitioners (NPPs). These changes define a prescriptive authority agreement as a separate and distinct arrangement, and scrap the definition of medically underserved area. These changes will enable physicians to lead physician assistants and advanced practice registered nurses more effectively in collaborative practice.

TMA's new evening seminar, NPP Regulations: Rules You Need to Know, will teach you and your staff about the new required prescriptive authority agreements, quality assurance plans, and more. Physicians, NPPs, and office managers should all attend to learn their altered responsibilities under the new supervision framework and how to avoid legal pitfalls. Hors d'oeuvres will be served during check-in, and all attendees will receive a sample prescriptive authority agreement.

Can't attend in person? On May 15, TMA will webcast this seminar over the Internet. You can watch and participate just like you would in person. 

To reflect recent changes in the law, TMA has released an updated second edition of its best-selling publication Nonphysician Practitioners: Hiring, Billing, and Delegation of Duties for a Nonphysician Practitioner. Contact TMA at (800) 880-1300, ext. 1415, if you recently purchased the first edition of this publication.

Visit the TMA Education Center to attend a live seminar in your area, register for the May 15 live webcast seminar, or purchase the publication.

Stage 2 Meaningful Use Incentive Calculator Now Available

Determine your incentive payment eligibility in the Stage 2 meaningful use electronic health record (EHR) incentive programs with the new calculator developed by the Centers for Medicare & Medicaid Services. Just enter and review your data for each meaningful use measure. 

Getting started with the calculator involves four easy steps:  

  1. Select provider type ("eligible professional" for physicians). 
  2. Answer questions on your meaningful use core objectives. 
  3. Answer questions on your meaningful use menu objectives. 
  4. Receive your results. 

Remember: The calculator is a tool that allows you to determine whether you are meeting the meaningful use metrics and are able to successfully attest to meaningful use. Once you are certain you have met the requirements, you can then attest to meaningful use for the 2014 quarter you have chosen. 

Physicians who need assistance with the EHR incentive program may receive consulting help from one of four Texas regional extension centers (RECs). The RECs are qualified to help physicians navigate the complexities of the program. Check out TMA's REC Resource Center to find out which REC serves your area. 

For more information about EHRs or other health information technology issues, email TMA's HIT Department or call (800) 880-5720. 

     TMAIT Action Ad 4.13  

Law Sheds Light on Industry Payments to Physicians

Later this year under the Physician Payments Sunshine Act, the Centers for Medicare & Medicaid Services (CMS) will make public physician payments reported by manufacturers of drugs, medical devices, and biologicals that participate in federal health care programs.

The law, which took effect Aug. 1, 2013, is part of the Affordable Care Act and requires manufacturers and group purchasing organizations to report ownership interests held by physicians and their immediate family members.

On Feb. 18, CMS opened payments registration and data submission for applicable manufacturers and group purchasing organizations for the 2013 reporting year. 

The American Medical Association anticipates that between June and August, CMS will launch an online portal where physicians can sign up to be notified when their financial disclosures are available for review and correction. At that time, physicians can review their reports and challenge them if they are false, inaccurate, or misleading. CMS says it will provide physicians access to their consolidated financial disclosures for the prior calendar year. According to AMA, CMS will release most of the data on a public website by September.

AMA's online toolkit features a webinar on preparing for the Sunshine Act, an overview of the financial interactions and ownership interests that will be reported, an explanation of the excluded financial interactions, answers to frequently asked questions, and a summary of the act's key provisions. 

AMA advises physicians to: 

  • Ensure all financial and conflict-of-interest disclosures required by employers and other entities that provide funding are current and updated regularly; 
  • Update professional information and ensure the correct specialty designation; 
  • Learn what financial transfers and ownership interests must be reported by drug and device manufacturers and group purchasing organizations; and 
  • Ask industry contacts to provide transfer information in advance for an opportunity to correct the information before it's transmitted to the government. 

The Open Payments Mobile for Physicians app allows you to capture and confidentially collect information on reportable transfers between you and industry representatives. This information comes in handy should you need to challenge any inaccurate information reported to the government. Download the app on your Apple or Android device.

Note: The Sunshine Act stipulates payments or other transfers of value provided as compensation for speaking at a continuing medical education (CME) program are not required to be reported if the following conditions are met: 

  • The activity meets the requirements of the continuing education accrediting agency, e.g., the Accreditation Council for Continuing Medical Education; 
  • The pharmaceutical or device company does not pay the speaker directly; and 
  • The pharmaceutical or device company does not choose the speaker or give the CME provider a group of speakers to consider for the activity.  

Most of the information contained in the reports will be available on a public, searchable website.

Umbilical Cord Blood Banking

Pregnant Couple

Umbilical cord blood stem cell transplants are used to treat a variety of oncologic, genetic, hematologic, and immunodeficiency disorders. Physicians have an important role in educating, counseling, and offering umbilical cord blood donation and storage options to patients. 


TMA has provided the following information to help you inform and educate your patients about cord blood banking.

Benefits of Cord Blood Collection and Use 
Umbilical cord blood is the blood that drains from the placenta and umbilical cord after the delivery of a stable infant. Cord blood can be collected without risk to mother or baby. Cord blood stem cells are not embryonic stem cells. If not donated to a bank, this material is discarded as waste. Umbilical cord blood has many advantages over traditional stem cell sources, but one of the most important is its quick availability once a match is identified for a patient.

Public Versus Private Banking
Cord blood banking can be done with a private or public cord blood bank. There is no cost to donate to public cord blood banks, and donated units are available for any patient listed on the national registry.

Private banks charge patients a collection and storage fee. Collected units are available only for use by the person who provided the cord blood or her immediate family members, greatly limiting the potential usefulness of the blood. Patients also should be aware that private banks may vary greatly in their processing and storage procedures and quality control measures.

Donating Cord Blood 
In Texas, there are two public banking facilities that collect, process, and store umbilical cord blood: the Texas Cord Blood Bank and MD Anderson Cord Blood Bank. These banks partner with hospitals locally and throughout Texas for the collection of donated cord blood. Donation services are not offered in all hospitals or all cities. These participating hospitals accept donations.

Patients should check with their intended delivery hospital before the 34th week of pregnancy if they wish to have their cord blood donated. If the patient’s hospital does not participate in the program, the patient may contact the Be the Match registry between her 28th and 34th week of pregnancy to request a cord blood donation kit.

Among racial and ethnic minority populations, including African-American and Hispanics, there is a disproportionate need for stem cell transplants due to the lack of minority donors on the cord blood and bone marrow donor registries. Educating these patients on cord blood donation and encouraging all eligible patients to donate is recommended to ensure an adequate supply for Texas’ large and diverse population.

State Requirements and Resources for Physicians
In 2007, House Bill 709 was passed requiring physicians practicing in Texas to provide a patient a brochure on umbilical cord blood options “before the third trimester of the woman’s pregnancy or as soon as reasonably feasible.”

The Texas Department of State Health Services (DSHS) provides the brochure Information on Umbilical Cord Blood Banking and Donation in English and Spanish, free of charge.

umbilical cover smallerOrdering Information
To order brochure copies, visit, call (512) 250-7116, or fax DSHS using Form No. AG-30 to (512) 250-9360. In the blank text box provided at the top of the fax form, include your name, address, stock number 6-73, and quantity requested. Brochures will be mailed and delivered to your office in approximately one week.


TMA Policy TMA Policy 45.017 Umbilical Cord Blood encourages families to donate umbilical cord blood for public supply (Amended Res. 305-A-06).

National Guidelines and Recommendations 
The American Academy of Pediatrics, the American College of Obstetricians and Gynecologists (ACOG), the American Medical Association, the American Society of Blood and Marrow Transplantation (ASBMT), and the World Marrow Donor Association have published guidelines regarding umbilical cord blood.

Key recommendations are:

  • Parents should be encouraged to donate umbilical cord blood to public banks, which accept donations free of charge and provide stem cells to anyone who needs them. 
  • Cord blood banking should be recommended through the Related Donor Cord Blood Program when the donor's sibling has an illness that may be treated with a cord blood transplant (this program stores cord blood units for the exclusive use of the donor family).
  • Private banking for unidentified possible future use is not currently recommended.

Additional Information and Resources
American Academy of Family Physicians — Umbilical Cord Blood: A Guide for Primary Care Physicians
ACOG — Umbilical Cord Blood Banking: Committee Opinion
AMA — Opinion: Umbilical Cord Blood Banking
ASBMT — Should You Store Your Baby's Umbilical Cord Blood?
Be the Match — Cord Blood and Transplants

Sources: Be the Match. Key Facts. Jan 2013. 

Physicians Help Create a Healthy Economy

Physician practices add value to Texas' economy by producing tens of billions of dollars in revenue each year and providing hundreds of thousands of jobs. "The National Economic Impact of Physicians," a new study conducted for the American Medical Association and state medical societies, found Texas' 48,314 practicing physicians boost the state's economy by supporting 522,619 jobs and generating $78.6 billion in economic activity.

TMA President Stephen L. Brotherton, MD, said, "Unlike last week's Medicare payment data dump, these numbers are supported by solid analysis and reported in rich context. The bottom line is that Texas' physician practices, without a doubt, are good for the economic health of our communities and our state."

The economic benefit of doctors' offices goes beyond the hundreds of thousands of direct jobs they support, including the quite-quantifiable ripple effect of those jobs and tax dollars through the local economy.

"Physicians carry tremendous responsibility as skilled healers charged with safeguarding healthy communities, but their positive impact isn't confined to the exam room," said AMA President Ardis Dee Hoven, MD. "The new study illustrates that physicians are strong economic drivers that are woven into their local communities by the economic growth, opportunity, and prosperity they generate." 

The findings in Texas cover these four key economic barometers: 

  • Jobs: Each physician supported an average of 10.8 jobs and contributed to a total of 522,619 jobs statewide. 
  • Output: Each physician generated an average of $1,627,498 in economic output and contributed to a total of $78.6 billion statewide. 
  • Wages and Benefits: Each physician supported an average of $890,990 in total wages and benefits and contributed to a total of $43 billion statewide. 
  • Tax Revenues: Each physician supported $52,618 in local and state tax revenues and contributed to a total of $2.5 billion statewide.  

The report found that Texas physicians generate significantly more economic output (i.e., medical and nonmedical sales revenues) than the legal industry; produce more jobs than colleges, universities, and nursing homes combined; and pay more in wages and benefits than all Texas hospitals. 

Across the country, the nation's 720,000 practicing physicians support 9.9 million jobs, generate $1.6 trillion in economic activity, support $775 billion in wages and benefits, and generate $65.2 billion in state and local tax revenue. Visit the AMA website to view the full national report and an interactive map of the United States.

"The National Economic Impact of Physicians" was prepared for AMA by IMS Health.

File Your Franchise Tax Reports by May 15

Annual franchise tax reports are due May 15. 

Beat the rush to file your franchise tax report or request an extension by using WebFile to electronically file reports.

TMLT Action Ad 4.13    

DSHS Offers Newborn Screening Requirement Guidance

The College of American Pathologists (CAP) issued a new specimen tracking requirement for CAP-accredited laboratories that submit newborn screening specimens to the Texas Department of State Health Services (DSHS) laboratory for testing. Phase I of the requirement applies to specimens submitted to a remote testing laboratory for screening for congenital disorders in newborns. 

CAP requires "a documented tracking system to ensure that all specimens are submitted in compliance with timing requirements and that a result or other appropriate notification is received indicating that the specimens were actually received."

To meet the requirement, DSHS recommends labs use the Texas Newborn Screening Web Application (Neometrics).  

Using the web application allows health professionals to:

  • Enter patient demographic information.
  • Search and print newborn screening result reports 24/7.

Once the DSHS lab receives and scans the electronic demographic information for each newborn screen specimen into the Laboratory Information Management System, it will appear in the health professional's web application account. Note: Demographic entry of specimens is not necessary to view or retrieve result reports.

The DSHS Laboratory Quality Assurance Group has consulted with CAP and confirmed that health care professionals can meet the specimen tracking requirement by acknowledging receipt of a result report for each specimen submitted. 

Visit the DSHS remote data systems FAQ page for more information about the Texas Newborn Screening Web Application. Or call DSHS at (888) 963-7111, ext. 7333, or email NewbornScreeningLab[at]dshs[dot]state[dot]tx[dot]us.

Memorial Hermann, DocbookMD Deal Connects Houston Physicians

DocbookMD has signed an agreement to deploy Docbook Enterprise to MHMD Memorial Hermann Physician Network of Houston. This is a big win not only for physicians at MHMD, who will gain significant communication and workflow advantages, but also for the whole Houston community. DocbookMD, the HIPAA-secure mobile communication app, provides the ability to connect physicians at MHMD to one another as well as to other TMA-member physicians across Houston.

This sets DocbookMD apart from other communication platforms. DocbookMD gives physicians the ability to connect to other physicians and health care resources within an entire region. Most technologies use a closed network that allows physicians within a hospital or group to communicate securely only with colleagues and staff who are inside that organization. But DocbookMD's guiding vision has always been to break down the barriers that prevent physicians from sharing critical communications with all of those involved in their patients' care. 

DocbookMD is available to all TMA members as a free member benefit. Across the country, more than 25,000 physicians in 40 states use DocbookMD, further connecting the community of medicine. DocbookMD is available for iPhone, iPad, and Android devices as well as PC and Mac via the new web version. The app can be downloaded using the Apple App Store or Google Play.

Docbook Enterprise offers a scalable and secure way for groups and hospitals to meet a wide variety of workflow needs and enhance existing technology systems. To bring the enterprise version of DocbookMD to your hospital or large group, contact DocbookMD Director of Partnerships Chad Shepler by email or phone at (512) 383-5822.

Apply for the 2013-14 Texas Physician Practice Quality Improvement Award

Texas physician practices continue to make great strides in providing reliable preventive services by using health information technology and effective care management methods. These practices should be recognized for their hard work.

Quality Improvement Award LogoTMF Health Quality Institute, TMA, and the Texas Osteopathic Medical Association have partnered again to provide the Texas Physician Practice Quality Improvement Award program. Learn more about the award program and prepare to apply by June 13. The online application will soon be available. 


Four Reasons to Attend the Texas Health Home Summit

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

Here are four reasons you should attend: 

  1. Learn what your peers are doing to address the recently released National Committee for Quality Assurance Patient-Centered Medical Home 2014 recognition standards. 
  2. Explore the challenges and opportunities of the Medicaid 1115 waivers.
  3. Attend a pre-summit presentation on integrating mental health into primary care through medical and health homes like the Meadows Foundation's new Meadows Mental Health Policy Institute.
  4. Attend a pre-summit session on how information technology can help you achieve quality measures and medical home status. 

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 among families, health professionals, and the health care system. 

Albert C. Hergenroeder, MD, chief of Baylor College of Medicine's Adolescent Medicine and Sports Medicine section, and Jennifer Markley, RN, TMF Health Quality Institute's senior director for quality improvement, will headline a session on care transitions. 

Amy Gibson, chief operating officer of the Patient-Centered Primary Care Collaborative in Washington, D.C., will address recent studies on the effectiveness of the health home. 

Continuing medical education credit information for the summit will be announced soon. Email Stephanie Ondrias with questions.

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.

This Month in Texas Medicine

The May issue of Texas Medicine encourages physicians and their staff to continue preparing for ICD-10, despite the one-year implementation delay; highlights a state pilot project aimed at streamlining care for dual-eligible patients; introduces Texas' new medical school deans; tells the story of a hospital and physicians who reached an agreement in a dispute over obstetric privileges; and features the 2013 TMA Annual Report.

Click to launch the full edition in a new window.

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. 


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

May 12, 2020