Action: Aug. 1, 2014

TMA Action Aug. 1, 2014   News and Insights from Texas Medical Association

INSIDE: Congress Passes VA Overhaul

Congress Passes VA Overhaul
TMA Asks Feds for Emergency Halt of EHR Rules
TMF Health Quality Institute Wins QIO Contract
CDC Issues Ebola Virus Advisory
Committee to Focus on Strengthening Health Care Workforce
Tell FDA to Regulate All Tobacco Products
Brush Up on Patient Records Requirements for Meaningful Use
Be on the Lookout for Cyclospora

Plan to Attend TMA Fall Conference Sept. 12-13
In Search of the Best Health News of 2014
Fund a Vaccination Event With Help From Be Wise — Immunize
Get Involved in Mental Health Town Hall Discussions
Wanted: Team Sports Physicians
DocbookMD Is the Physician's Choice Nationwide
This Month in Texas Medicine

Congress Passes VA Overhaul

On Thursday, Congress approved a widespread overhaul of the embattled Department of Veterans Affairs (VA). TMA has been calling on the nation's leaders to clear existing bureaucratic landmines  slow payment and lack of interaction between the VA and the private sector, for instance  so private-sector physicians can help get veterans the timely care they need. 

The legislation pours $10 billion into helping those veterans who can't get a VA appointment within 30 days or who live more than 40 miles from the nearest VA facility obtain health care outside the VA system from private-sector physicians and at Department of Defense or Indian Health Service facilities.

The law's $17 billion in total emergency funds includes $5 billion that allows the VA to hire new employees and $1.3 billion to lease 27 new medical facilities. The law prohibits the VA from using wait times to gauge workers' job performance, instead focusing on quality of patient care.  

Last month, TMA President Austin King, MD, unveiled TMA's registry of private physicians willing to see patients in the VA health care system. Dr. King shared information about the registry with the director of every VA hospital, clinic, and veteran center in the state. 

TMA developed the registry after the American Medical Association House of Delegates, at the urging of Texas physicians, voted overwhelmingly to ask President Barack Obama to provide timely access to entitled care for eligible veterans through the health care sector outside the VA system until the VA can provide care in a timely fashion.

So far, more than 350 TMA member physicians have signed up for the association's registry. If you haven't signed up for the registry, please go to the TMA website and check the "I am willing to serve veterans" box.

TMA Asks Feds for Emergency Halt of EHR Rules

In a letter to Centers for Medicare & Medicaid Services Administrator Marilyn Tavenner, Matt Murray, MD, specified several concerns TMA has with the agency's proposed modifications to the 2014 Medicare and Medicaid electronic health record (EHR) incentive programs. 

In the letter, the chair of the TMA Ad Hoc Committee on Health Information Technology requests emergency suspension of the certified EHR requirement that physicians use a certified patient portal and the Stage 2 meaningful use requirement that 5 percent of patients view, download, or transmit their information using the patient portal.

"Instead, for 2014 it should be adequate that the physician provides an electronic copy of the Consolidated Clinical Document Architecture (C-CDA) summary that the patient can upload to a portal of his or her choice," TMA recommends, adding that "failure to do this will result in portal silos that will be detrimental to patient satisfaction and care."

In addition to the patient portal requirement, TMA's letter identifies health information exchanges (HIEs) as a "factor causing physician non-participation in meaningful use Stage 2." The association says HIEs are maturing but have yet to connect many physicians. "Physicians are concerned about being held liable for HIPAA violations outside of their control after submitting protected health information (PHI) to the local HIE," Dr. Murray writes.

Questions TMA would like CMS to answer include: 

  • Has CMS conducted patient studies to see whether a majority are interested in accessing their patient portal?
  • Has CMS conducted studies to determine improved outcomes based on patient access to health information?
  • Has CMS studied the impact of creating separate silos of patient information versus having a single consolidated personal health record? 

"While TMA agrees that patient engagement and accountability are good for health care, the requirement for meaningful use needs significant revision," the letter states.

TMF Health Quality Institute Wins QIO Contract

The TMF Health Quality Institute won the five-year Quality Innovation Network Quality Improvement Organization (QIN-QIO) contract with the Centers for Medicare & Medicaid Services (CMS) for Texas, Arkansas, Missouri, and Oklahoma.

"CMS has again recognized TMF as a leader in health care quality improvement with the award of a five-year, multistate contract to continue expanding the quality of care for Medicare beneficiaries," said David Fleeger, MD, chair of the TMF Board of Trustees and a member of the TMA Board of Trustees.

In May, CMS announced changes to its QIO program structure, including a multistate regional approach to replace state-specific QIOs for quality improvement work, designated the QIN-QIO Program. 

"TMF looks forward to expanding our quality improvement work throughout a larger region," said Tom Manley, TMF president and chief executive officer. "For more than 30 years, we have been dedicated to improving the quality of care for Medicare beneficiaries in Texas, and with our strong alliances throughout Arkansas, Missouri, and Oklahoma, we are ready to continue this important work.”

In January, TMA wrote a strong letter in support of TMF to Kathleen Sebelius, former secretary of the U.S. Department of Health and Human Services, and CMS Administrator Marilyn Tavenner. 

"The Texas Medical Association has longstanding policy in support of TMF Health Quality Institute as the statewide quality improvement organization of Texas. We support TMF as the sole quality improvement and peer review organization for state and federal programs and recognize TMF's due process and peer review for all health care programs in the state that are fully or partially funded by federal dollars," wrote then-TMA President Stephen L. Brotherton, MD. 

TMF's contract focuses on: 

  • Improving cardiac health and reducing cardiac health care disparities;
  • Reducing disparities in diabetes care;
  • Improving prevention efforts through meaningful use of health information technology;
  • Reducing infections in hospitals;
  • Reducing harm in nursing homes;
  • Assisting physicians and hospitals with quality reporting; and
  • Helping communities improve the coordination of health care for patients to help reduce unnecessary hospital readmissions.

The QIN-QIO contract award is the second phase of QIO program restructuring. CMS made major changes to the QIO program this year, electing to separate medical case review from quality improvement efforts.

In May, CMS announced the award of case review work, designated as the Beneficiary and Family-Centered Care QIO Program contract, to Ohio-based KePRO for Texas, 32 other states, and the District of Columbia. The organization will handle all Medicare case review activities in the designated regions starting Aug. 1.

CDC Issues Ebola Virus Advisory

Recent cases of Ebola virus disease (EVD) underscore the potential for travel-associated spread of the disease and the risks of EVD to health care workers, according to the Centers for Disease Control and Prevention (CDC), which issued a health advisory July 28. 

Nigerian health authorities confirmed a diagnosis of EVD in a patient who died on Friday in a hospital in Lagos, Nigeria, after traveling from Liberia on July 20, 2014. The report marks the first Ebola case in Nigeria linked to the current outbreak in the West African countries of Guinea, Sierra Leone, and Liberia. Health authorities also reported two U.S. citizens working in a hospital in Monrovia, Liberia, have confirmed Ebola virus infection. 

CDC is working with the World Health Organization (WHO), the ministries of health of Guinea, Liberia, and Sierra Leone, and other international organizations in response to an outbreak of EVD in West Africa, which was first reported in late March. As of July 23, according to WHO, 1,201 cases and 672 deaths (case fatality, 55 percent to 60 percent) had been reported in Guinea, Liberia, and Sierra Leone. This is the largest outbreak of EVD ever documented and the first recorded in West Africa. 

According to CDC, EVD is characterized by sudden onset of fever and malaise, accompanied by other nonspecific signs and symptoms, such as myalgia, headache, vomiting, and diarrhea. Patients with severe forms of the disease may develop multiorgan dysfunction, including hepatic damage, renal failure, and central nervous system involvement, leading to shock and death. 

EVD poses little risk to the U.S. general population at this time. However, CDC advises U.S. health care workers to be alert for signs and symptoms of EVD in patients with compatible illness who have a recent (within 21 days) travel history to countries where the outbreak is occurring, and should consider isolation of those patients meeting these criteria, pending diagnostic testing. 

Visit the CDC website for more information on EVD and for interim guidance on EVD for health care workers.


Committee to Focus on Strengthening Health Care Workforce

Texas House Speaker Joe Straus created the Select Committee on Health Care Education and Training, which will focus on preparing more Texans for careers in the state's growing health sector. 

Committee members will assess the demand for health professionals across the state. They will also examine ways to better align public schools, as well as colleges and universities, with the needs of health care employers.

"The strength of our health care workforce directly impacts the quality of care that Texans receive," said Speaker Straus (R-San Antonio). "It also matters a great deal to our economy. Too many health jobs are unfilled, while too many Texans are not prepared to succeed in the workforce. The work of this committee will help more Texans prepare for successful careers in a very important field." 

Rep. Susan King (R-Abilene) will chair the committee. 

"As a nurse and a former school board member, Representative King understands the needs of our schools and our health care providers," Speaker Straus said. "I am confident that she and all of the members of this committee will provide valuable leadership as we address this issue in the next legislative session." 

Last year, the legislature approved House Bill 5, which encourages high schools and colleges to work more closely with industry to prepare students for workplace success. The Committee on Health Care Education and Training will continue that legislation's emphasis on workforce readiness. 

Texas faces severe shortages in the health care sector. Of the state's 254 counties, 177 have an all or partial health professional shortage area designation, given this year by the U.S. Health Resources and Services Administration. And 207 counties are shortage areas for mental health services. Many of the jobs that see persistent shortages do not require four-year college degrees. 

In addition, Texas hospitals experience higher vacancy and turnover rates for nurses than similar states. Such rates are even higher in nursing homes and assisted living facilities.

Tell FDA to Regulate All Tobacco Products

The Campaign for Tobacco-Free Kids is urging public comment in support of regulation of all tobacco products, including electronic cigarettes and cigars, by the Food and Drug Administration (FDA). Click here to submit your comments directly to the FDA. The submission deadline is Aug. 8.

If you need help, the campaign has developed sample comments you can adapt and use.

Additionally, the TMA House of Delegates adopted policy related to regulation of electronic cigarettes at TexMed 2014 in May. The policy from the TMA Council on Science and Public Health recommends TMA work with the Texas Department of State Health Services to develop communications for physicians to share with patients on e-cigarettes and associated products and to encourage the Texas Quitline to identify the use of e-cigarettes by callers. The policy also encourages physicians to work with their county medical societies and local public officials to ensure that current smoke-free ordinances include e-cigarettes and associated products and to work with the Texas Legislature to restrict the purchase of e-cigarettes and associated products by minors.

Brush Up on Patient Records Requirements for Meaningful Use

The Centers for Medicare & Medicaid Services (CMS) requires 80 percent of a physician's patients to have records in the certified EHR technology (CEHRT) to meet certain objectives and measures of the electronic health record (EHR) incentive program. For example, the following Stage 1 measures require that more than 80 percent of patients seen by the physician have at least one entry in the EHR: 

  • Up-to-date problem list of current and active diagnoses;
  • Active medication list; and
  • Active medication allergy list.

For more information, view the CMS document that outlines the individual measures. Plus, TMA's EHR Implementation Guide offers a nontechnical view of the steps necessary for the successful introduction of health information technology with an emphasis on the needs of smaller practices. 

If you have questions about the EHR incentive program, visit the TMA website, or contact TMA's Health Information Technology Department by telephone, (800) 880-5720, or by email.  

Be on the Lookout for Cyclospora

The Texas Department of State Health Services (DSHS) encourages health care professionals to test for Cyclospora in patients who have diarrheal illness lasting more than a few days or diarrhea accompanied by severe anorexia or fatigue. 

Diagnosis of cyclosporiasis requires submission of stool specimens for ova and parasite testing with additional specific orders for Cyclospora identification. The department stresses a single negative stool specimen doesn't exclude the diagnosis; three specimens are optimal. 

Symptoms of cyclosporiasis usually begin two to 14 days after ingestion of oocysts in contaminated food or water. DSHS says profuse diarrhea can last weeks to months and may relapse. Additional symptoms may include anorexia, fatigue, weight loss, abdominal cramps, bloating, increased gas, nausea, vomiting, and low-grade fever.

Health care professionals and laboratories should promptly report confirmed cyclosporiasis cases to their respective local health department or DSHS by calling (800) 705-8868 or faxing (512) 776-7616.

Within the past month, DSHS has received reports of 34 cases of Cyclospora infection. The department is investigating the increased number of cases of Cyclospora infections to identify possible common exposures. 

A common exposure source for this increase hasn't yet been identified. Past U.S. outbreaks have been associated with consumption of imported fresh produce, including fresh cilantro, prepackaged salad mix, raspberries, basil, snow peas, and mesclun lettuce. 

For more information about Cyclospora, visit the CDC website

TMAIT Action Ad 7.14 

Plan to Attend TMA Fall Conference Sept. 12-13

Mark your calendar for TMA Fall Conference Sept. 12-13 at Hyatt Regency Lost Pines Resort & Spa in Bastrop. The conference provides an opportunity for physicians and medical students to conduct TMA business, obtain continuing medical education, and network with peers. 

This year, the conference visits a new venue just 30 minutes from downtown Austin. In addition to conference events, attendees can enjoy a variety of amenities at Hyatt Lost Pines, including golf, spa time, horseback riding, hiking, archery, tennis, and a water park.

TMA's special room rate is $199 for single or double occupancy. Reserve a room by calling (888) 421-1442 and asking for the TMA Fall Conference discount, or reserve your room online. The deadline to receive this special rate is Thursday, Aug. 21. Sleeping rooms are subject to a 7-percent occupancy tax rate. Local sales tax is 6.75 percent.

Register online today. The conference is a free benefit for members. Contact the TMA Knowledge Center by phone at (800) 880-7955 or by email with questions. 

Plus, physicians and their families, medical students, and office staff can get their annual flu vaccination and more during the conference. TMA will offer flu, tetanus-diphtheria-pertussis (Tdap), and measles-mumps-rubella (MMR) vaccinations from 7:45 am to 9 am on Saturday, Sept. 13. 

This year, a variety of flu vaccination options, including the quadrivalent vaccination, will be available. TMA physician members will be on hand to answer your questions about flu shots. Costs for the vaccinations, payable onsite by cash or check, are:  

  • Quadrivalent flu shot (protects from four strains): $40;
  • High-dose flu shot (for ages 65 years+): $40;
  • Intradermal flu shot (1.5 mm “micro-needle”): $32;
  • FluMist (nasal spray): $40;
  • Egg- and thimerosal-free flu vaccine (no egg or mercury-based preservative): $32;
  • Tdap : $80; and
  • MMR: $105.

Be sure to reserve your vaccination when you register for the conference. The event is sponsored by TMA's Committee on Infectious Diseases and Be Wise — ImmunizeSM

Be Wise — Immunize is a joint initiative led by TMA physicians and the TMA Alliance, funded by the TMA Foundation through generous grants from H-E-B and TMF Health Quality Institute, and gifts from physicians and their families. 

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

In Search of the Best Health News of 2014

The TMA Anson Jones, MD, Awards honor outstanding health journalism, and we need your help to find the best stories of 2014. Maybe you’ve seen, heard, or read something that caught your attention on a new medical treatment, health disparities, obesity or other health concern, or the border crisis. 

If so, nominate it for an Anson Jones award. TMA family (physicians, medical students, TMA Alliance members, and county medical societies) nominated six of the 21 winning entries in this year's Anson Jones competition. Award categories cover print, broadcast (television and radio), and online media. Any story from 2014 is eligible.

When you nominate a journalist, you recognize him or her for a job well done. Simply email your nomination: the reporter's name, name of article (if available), date of broadcast/publication, and the media outlet. Please try to include a URL. 

TMA will send the reporter a postcard with a handwritten note. We’ll let the reporter know you nominated him or her and for which story or broadcast. 

Visit the Anson Jones webpage for complete nomination details, contest rules, and categories. If you have questions, call Tammy Wishard, TMA outreach coordinator, at (800) 880-1300, ext. 1470 or (512) 370-1470, or email her.

Fund a Vaccination Event With Help From Be Wise — Immunize

TMA's Be Wise — ImmunizeSM program is accepting applications until Oct. 1 for funds to support local vaccination events. Grants of up to $2,000 are available to TMA member-physician practices and clinics, county medical societies, TMA Alliance chapters, and medical student chapters. Monies can be used for new or expanded shot clinics to immunize underserved and uninsured children, adolescents, and/or adults. 

In April, a record 11 local-impact grants were awarded for projects to vaccinate Texans against flu, human papillomavirus, pertussis, bacterial pneumonia, and other vaccine-preventable diseases.

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 (800) 880-1300, ext. 1470, or (512) 370-1470.

TMA launched the Be Wise — Immunize program in 2004 to increase Texas' immunization rates. Since then, the program has provided more than 255,000 shots to Texas children, adolescents, and adults. 

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 gifts from physicians and their families. 

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

Get Involved in Mental Health Town Hall Discussions

Mental health issues can leave people feeling isolated and ashamed. To counter misconceptions about mental illness and help connect people with resources, the Texas Department of State Health Services (DSHS) launched Speak Your Mind Texas, a statewide conversation about mental health that help is available and recovery is possible.

DSHS is working with local organizers to conduct town hall-style community conversations around Texas this summer to spark discussion about mental health and substance abuse.

Upcoming events include:

Aug. 4: El Paso
2-5 pm
Family Youth Service Center

Aug. 12: Waco
2-5 pm
Baylor Scott & White – Hillcrest, Auditorium 

Aug. 13: San Antonio
6-9 pm
Whitley Center at the Oblate School Of Theology 

Aug. 18: Lufkin
1:30–4 pm
Pitser Garrison Convention Center 

Aug. 19: Austin
6-9 pm
Location to be determined

RSVP for events, download event flyers, and get updated information online.

Speak Your Mind Texas is part of an overall Texas effort to raise awareness of mental health issues and increase access to services. The Texas Legislature appropriated more than $300 million in additional mental health funding for 2014-15. The funds help expand services, decrease wait lists, make improvements at the state's mental health hospitals, and develop targeted efforts for veterans and young people.   

   PC Action Ad June 13 

Wanted: Team Sports Physicians

A TMA Hard Hats for Little Heads bike helmet giveaway provides a great way for physicians to give back to their communities and stresses the importance of helmet safety to avoid injury. TMA is working toward a huge goal this year — giving 34,000 Texas children a new helmet — to celebrate 20 years of keeping kids safe (Hard Hats' 20th birthday). 

Team doctors, we need your help to reach the goal. Sign up with your high school, college, or professional team today to sponsor a helmet giveaway during TMA's statewide event in October, when we want to give 5,000 Texas children a helmet. Any time during your team's season before the end of the year is a great time for an event. 

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

Join with your sports boosters association or PTA 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 schedule your 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.  

DocbookMD Is the Physician's Choice Nationwide

DocbookMD is being used by nearly 9,000 Texas physicians and more than 25,000 physicians nationwide to communicate important clinical information with colleagues and staff in a fast, HIPAA-secure way. In fact, it's working so well for them that many of those physicians are leading the charge to have their hospital, group, or accountable care organization (ACO) adopt the Enterprise version of DocbookMD.   

To date, Docbook Enterprise has been implemented at institutions in Texas (Memorial Hermann Physician Network in Houston, Seton Healthcare in Austin, Arise Management in Austin, Hospital Internists of Austin, Medical Clinics of Houston, Lakeway Regional Hospital in Austin, and Austin Diagnostic Clinic), Montana, Colorado, Connecticut, and Indiana. Pilot implementations are under way in Vermont and New Jersey. 

"In each case, physicians who had been introduced to DocbookMD through their state or county medical society liked it so much, they brought it to their hospital or group to solve the need for a secure way to communicate with other physicians and with their own staff," says DocbookMD cofounder Tracey Haas, DO. "It is important for physicians to take the lead in choosing solutions and technologies that work for them and fit seamlessly into their current workflow."

Docbook Enterprise offers increased ability to integrate with other technologies, including connecting with answering services, lab and radiology departments, health plans, ADT reports, and billing software, and virtually any other existing information technology. Docbook Enterprise provides a common dashboard to deliver critical results directly to the ordering physician and can aid in care coordination in many arenas — especially when an ACO is involved. 

To introduce 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.

This Month in Texas Medicine

The August issue of Texas Medicine tells the story of 100-plus physicians around the state who learned their Social Security numbers had been stolen after attempting to file their 2013 taxes. The issue also highlights legislation that has the potential to relieve administrative hassles in Medicaid managed care, the increasing use of medical scribes by physicians, TMA's support of postexposure prophylaxis, the new osteopathic medical school dean, and physicians who embrace Choosing Wisely.

Click to launch the 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.


PQRS: Deadline to Register to Participate in GPRO for 2014   


HIT: First-Year Participants: Deadline to Attest to Meaningful Use for the 2014 Medicare EHR Incentive Program  

HIT: Upgrade EHR for Meaningful Use Stage 2  

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.  

On-Demand Webinars

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

Physician Health and Wellness, ext. 1342

 Physician Well-Being for Life  
10/24-25 Dallas                  

Healthy Physicians: Healthy Patients 
9/27    El Paso  
10/4    Tyler  

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Last Updated On

November 09, 2017