Action: Oct. 15, 2014

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

INSIDE: Feds Enact Tougher Standards as Health Care Workers Contract Ebola

Feds Enact Tougher Standards as Health Care Workers Contract Ebola
Make a Plan, Vote for the Party of Medicine
Upgrade Your EHR by Jan. 1, 2015
Perform FGIs? Undergo Safety Training by May 1, 2015
Two Deaths From Enterovirus D68 Reported
Have You Met the New Company Doc? 
Get Critical Lab Values on Your Mobile Device via DocbookMD 
Attend the 2014 Texas Immunization Summit Nov. 5-7 
DSHS Offers Tutorial on Using PEP to Identify, Prevent Rabies 
Bike Helmet Record = 6,000 Kids Protected 
TMF to Lead Regional Health Care Improvement Initiatives 
This Month in Texas Medicine  

Feds Enact Tougher Standards as Health Care Workers Contract Ebola

The U.S. Centers for Disease Control and Prevention (CDC) is strengthening safety standards now that two Dallas health care workers have tested positive for the Ebola virus.

"The existence of the first case of Ebola spread within the U.S.  changes some things and it doesn't change other things," CDC Director Tom Frieden, MD, said during an Oct. 13 media briefing. "It doesn't change the fact that we know how Ebola spreads.  It doesn't change the fact that it's possible to take care of Ebola safely.  But it does change substantially how we approach it.  We have to rethink the way we address Ebola infection control, because even a single infection is unacceptable."

The three changes Dr. Frieden announced on Oct. 14 are:

  1. A manager to oversee infection control "every hour of the day."
  2. More training for health care workers — "ongoing, refresher, repeat training, including by two nurses from Emory who cared for Ebola patients."
  3. A limit on the number of staff providing care directly to patients with Ebola "so that they can become more familiar and more systematic in how they put on and take off protective equipment and they can become more comfortable in a healthy way with providing care in the isolation unit."

"We knew a second case could be a reality, and we've been preparing for this possibility," Texas Department of State Health Services (DSHS) Commissioner David Lakey, MD, said. "We are broadening our team in Dallas and working with extreme diligence to prevent further spread." 


Ebola virus information for physicians and health care workers

The U.S. Department of Health and Human Services (HHS) offers this updated guidance regarding the response to the current Ebola outbreak in West Africa and the confirmed cases in Dallas:  

The Centers for Disease Control and Prevention (CDC) and the HHS assistant secretary for preparedness and response also offer the following checklists:  

Physicians and other health professionals can access a recording of a webinar hosted by the HHS assistant secretary for preparedness and CDC on Ebola preparedness for the U.S. health care system. The webinar focuses on the Detailed Hospital Checklist for Ebola Preparedness, which highlights the activities all hospitals can take to prepare for the possibility of a patient exposed to Ebola arriving for medical care. CDC says hospital emergency managers, infection control officers, hospital leaders, and clinical staff will find the information particularly valuable. The checklist provides practical and specific suggestions to ensure hospitals can detect possible Ebola cases, protect their employees, and respond appropriately.

Health officials have interviewed the two workers at Texas Health Presbyterian Hospital in Dallas and are identifying any contacts or potential exposures, according to DSHS. People who had contact with them after symptoms emerged will be monitored based on the nature of their interactions and their potential exposure to the virus.  

A total of 76 people at the hospital might have had exposure to the initial patient, Thomas Eric Duncan, and all of them are being monitored for fever and other symptoms daily, Dr. Frieden said.

On Oct., 8, Mr. Duncan, the first known person to develop Ebola in the United States, died at Presbyterian Hospital. Dr. Lakey released this statement about Mr. Duncan's passing:

"The past week has been an enormous test of our health system, but for one family it has been far more personal. They lost a dear member of their family. They have our sincere condolences, and we are keeping them in our thoughts. The doctors, nurses and staff at Presbyterian provided excellent and compassionate care, but Ebola is a disease that attacks the body in many ways. We'll continue every effort to contain the spread of the virus and protect people from this threat."

Dallas Health and Human Resources, CDC, and DSHS staff have monitored all of Mr. Duncan's known community contacts daily. As of Oct. 13, none of them had developed a fever or shown other signs of the disease.

Visit the CDC Ebola website and the TMA website for the most updated information on the Ebola response. 

Make a Plan, Vote for the Party of Medicine

The barrage of political ads around the 10 pm news tells us it's election time. From U.S. senator to dog catcher, candidates are asking for your vote.

"Give the people what they want," said TEXPAC Board Chair Jerry Hunsaker, MD. "Get out and vote. TEXPAC has endorsed a slate of highly qualified candidates for statewide, judicial, and state House and Senate seats. So get out and vote for them."

Election Day is Tuesday, Nov. 4. Early voting runs from Monday, Oct. 20, through Friday, Oct. 31. In most counties, you may cast an early ballot at any election site. On Nov. 4, you may vote only at your home precinct.

"Some people took offense when I used to jokingly suggest, 'Vote early and vote often,'" Dr. Hunsaker said. "This is a simpler message: Vote early."

Political scientists say the best way to ensure you vote is to make a detailed plan in your head of where and when you will vote.

"Picture yourself at the public library at 7:15 on Wednesday morning," Dr. Hunsaker said. "And then make that picture a reality. Only by voting for, and electing, patient- and medicine-friendly candidates can we be assured of patient- and medicine-friendly public officials."

Upgrade Your EHR by Jan. 1, 2015

If you are participating in the electronic health record (EHR) meaningful use incentive program and haven't upgraded your EHR to the 2014 version yet, be sure to do so by Jan. 1, 2015. Some EHR vendors have already released 2014 certified versions of their products. You can check the certified health product list to see if your vendor has upgraded yet. 

Regardless of which stage of meaningful use you are in, all EHR incentive program participants must report on a full year of meaningful use in 2015. Tap into TMA resources in the EHR Incentive Program Resource Center.

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 (HIT) issues, contact TMA's HIT Department at (800) 880-5720 or by email.

 TMLT Action Ad 4.13 

Perform FGIs? Undergo Safety Training by May 1, 2015

Under Texas law, physicians performing fluoroscopically guided interventions (FGIs) must undergo safety training. Specifically, by May 1, 2015, physicians have to complete a minimum of 9 hours of AMA PRA Category 1 Credit™ in radiation safety awareness training. For more information, read the Texas Department of State Health Services (DSHS) Questions and Answers document. 

According to DSHS, "any organization, individual or group can provide the training if the curriculum has been reviewed and certified as Category 1 Continuing Medical Education. The Category 1 designation may be obtained from the Accreditation Council for Continuing Medical Education, the American Osteopathic Association, a state medical society, or an equivalent organization." The department adds that training providers can be found by searching the internet.

The FGI rules aren't the result of any legislation passed in Texas. As TMA understands it, the rules came about as part of an effort by the federal government to address concerns related to the potential for radiation overexposure. 

TMA reached out to DSHS for more information about the FGI regulations and received this response:

"The new radiation awareness training requirements … are due to the increased incidence of radiation over-exposures in other states resulting from the improper use of fluoroscopy and computed tomography radiation machines. In so doing, the department is taking a proactive approach by requiring, among other things, that users of fluoroscopic radiation machines receive radiation safety training specific to these machines and procedures so that the risk of dangerous and unnecessary radiation over-exposures is reduced in connection with performing fluoroscopically-guided interventional procedures. Heightening awareness of unnecessary radiation exposure to patients is of national concern and there are several campaigns to raise awareness in the medical community, such as Image Gently and Image Wisely."

TMA has received several complaints from physicians about the FGI regulations. The association is seeking clarification and likely will ask DSHS to reopen the rules and allow discussion, input, and potential changes.

Two Deaths From Enterovirus D68 Reported

A four-year-old New Jersey boy died Sept. 25, and a 21-month-old Michigan girl died Oct. 10, making them the first two confirmed deaths from enterovirus D68 (EV-D68). The Centers for Disease Control and Prevention (CDC) confirmed 594 cases of EV-D68 in 43 states, including Texas, as of Oct. 6. 

The Texas Department of State Health Services (DSHS) issued a health alert last month after learning nine residents of North and East Texas tested positive for EV-D68.

CDC says EV-D68 has been detected in specimens from four patients who died and had samples submitted for testing. The agency stresses the role EV-D68 infection played in these deaths is unclear at this time. State and local health departments continue to investigate.

According to CDC, EV-D68 can cause mild to severe respiratory illness. Mild symptoms may include fever, runny nose, sneezing, cough, and body and muscle aches. Severe symptoms may include difficulty breathing and wheezing. People with asthma may have a higher risk for severe respiratory illness. Health officials are encouraging families to get a flu shot to prevent the risks.

DSHS encourages health professionals to report clusters or outbreaks of respiratory illnesses (any etiology, any age group, any severity level), as well as any suspected EV-D68 patients with atypical manifestations (neurological symptoms), to their local health department

Also, CDC has information on enterovirus common prevention practices you can share with patients and their families. 

Clinicians should be aware of EV-D68 as a possible cause of acute, unexplained, severe respiratory illness, particularly in children. The DSHS health alert includes recommendations to help clinicians reduce the risk of EV-D68 infection, as well as the department's EV-D68 criteria for specimen submission. DSHS says specimen testing criteria are limited to:

  • Pediatric patients younger than 18 years who have been admitted to an intensive care unit suffering from severe respiratory illness with symptom onset no earlier than Aug. 1 and who have tested positive for enterovirus or enterovirus/rhinovirus, if such testing has been completed. Please note specimens may be submitted without previous enterovirus or enterovirus/rhinovirus testing.
  • Patients of any age with respiratory illness who are part of a suspected EV-D68 cluster as determined by the local health department.
  • Suspected EV-D68 patients of any age with atypical illness manifestations.  

In addition to meeting at least one of the criteria, DSHS says specimens must be accompanied by an EV-D68 patient-under-investigation form and a DSHS virology specimen submission form. See the DSHS specimen submission and collection protocol for more information. Local health departments can provide copies of the current investigation form and assist health professionals with specimen submission. Qualified specimens received by DSHS will be forwarded to CDC for enterovirus testing.

Access the CDC advisory for more information and guidance, including a link to a case reporting form and contact information for public health departments.

Have You Met the New Company Doc?

Back in the old days, way back before health insurance, the railroads and big chemical companies in Texas had their own physicians on site. The "company doctors" kept the workers on the job and at least reasonably healthy.

Fast forward a century to a time when most large businesses routinely provide health care coverage for their employees. Costs are rising. And sick or injured workers have to take time off to see the doctor. It's back to the future for the company doc.

As reported in October's issue of Texas Medicine, worksite wellness clinics are gaining popularity among many large corporations for their potential to lower health care costs and reduce employee absences. Rather than pay for each employee to visit a separate primary care physician, employers are contracting with medical groups that set up primary care clinics at the workplace. One recent report says worksite clinics allow employers more control over direct medical spending by reducing needless emergency department visits, increasing employees' on-the-job hours, and giving companies the ability to contract with specialty groups willing to exchange discounts for patient volume. 

There are benefits for the physicians, as well. Travis Bias, DO, left his private practice in Pflugerville and began working for Crossover Health, a California-based organization that provides worksite primary care across the country. Through Crossover, Dr. Bias practices at a company in Northwest Austin, which asked not to be identified. Dr. Bias says in private practice he often felt rushed, and he was unable to educate patients as much as he would've liked. Now, he says, he sees half the number of patients in a day, and his average appointment time is longer.

Read the full story in the magazine or online.


Get Critical Lab Values on Your Mobile Device via DocbookMD

You no longer have to wait by the fax machine, computer, or electronic health record for lab results. 

DocbookMD's latest clinical integration with Clinical Pathology Laboratories (CPL) allows users to report critical lab values directly to the ordering physician's mobile device or laptop at the moment the labs are completed. Critical values will be sent directly to the ordering physicians, wherever they are, on any device the DocbookMD app is running on.

Future enhancements will allow the customization of reporting so that each ordering health professional may choose which types of lab values are sent to them via the DocbookMD app. The lab values will all continue to be sent to physicians in the usual ways, but this clinical integration will allow for faster communication and action, ultimately improving patient care and coordination.

With more than 150 locations in 81 Texas cities, CPL has a presence across the entire state. Any TMA member can access this great feature free of charge through their county medical society membership. Contact DocbookMD by email or call (888) 930-2048 to learn more about how you can register for this CPL lab integration.

Attend the 2014 Texas Immunization Summit Nov. 5-7

The 2014 Texas Immunization Summit, scheduled for Nov. 5-7 in San Antonio, gives you an opportunity to gather information and tools to champion immunization in your community.

During the summit, nationally recognized speakers will share the latest information regarding vaccines and vaccine-preventable diseases, as well as education and advocacy strategies to help improve immunization rates across the country. Visit the summit webpage for more information.

DSHS Offers Tutorial on Using PEP to Identify, Prevent Rabies

The Texas Department of State Health Services (DSHS) and the Texas Health and Human Services Commission (HHSC) are offering a tutorial titled Identifying Rabies Exposures and Preventing Rabies Through Post-Exposure Prophylaxis.

The goal of this tutorial is to educate Texas Health Steps providers and others about best practices on how to identify exposure to the rabies virus, evaluate when rabies postexposure prophylaxis (PEP) is indicated, and implement correct administration as recommended by the Advisory Committee on Immunization Practices.

After completing the activities of this tutorial, physicians will be able to: 

  1. Identify exposure to the rabies virus; 
  2. Given a case study, evaluate when rabies PEP is indicated; and 
  3. Given a case study, demonstrate correct administration of PEP as one component of ethical patient care. 

DSHS is offering continuing medical education credit for this event for physicians, nurses, and social workers. DSHS designates this enduring activity for a maximum of 0.75 AMA PRA Category 1 Credit™.  

PC Action Ad Oct 13 

Bike Helmet Record = 6,000 Kids Protected

Huge shout-out to the TMA family! Thanks to your collective efforts, TMA's Hard Hats for Little Heads is putting more than 6,000 helmets on Texas children in October. That's the most helmets we've ever given in one month. TMA declared October as Hard Hats for Little Heads Month to mark the program's 20th birthday and to celebrate 20 years of keeping kids safe. 

"This month represents 20 wonderful years of TMA giving and saving the lives of little Texans, one helmet at a time," said Ernest D. Buck, MD, a Corpus Christi pediatrician and chair of TMA's Council on Health Promotion, which oversees the Hard Hats program. "Fitting helmets at an event is personally rewarding, giving a hands-on way to interact with children and teach the importance of always wearing the helmet."

All year, TMA has rallied your involvement, and you heeded the call to help us not just meet — but exceed — our lofty goal to give away 5,000 helmets statewide this month. Physicians, medical students, county medical societies, TMA Alliance chapters, and other volunteers will give 6,151 helmets at 44 events statewide. Special thanks to the Texas Academy of Family Physicians and the Texas Pediatric Society, which both supported multiple events for their members. 

Look for an event in your community

Hard Hats continues to push to give a record 34,000 helmets in 2014. To find out how you can sponsor a Hard Hats event, email Tammy Wishard, TMA's outreach coordinator, or call (800) 880-1300, ext. 1470, or (512) 370-1470. 

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. 

TMF to Lead Regional Health Care Improvement Initiatives

The TMF Health Quality Institute has been designated the Quality Innovation Network-Quality Improvement Organization (QIN-QIO) by the Centers for Medicare & Medicaid Services (CMS) for Arkansas, Missouri, Oklahoma, Puerto Rico, and Texas.

TMF has built a strong quality improvement team throughout the multistate region to form the TMF QIN-QIO. Developing and maintaining strong partnerships with physicians, providers, state associations, and other state and local stakeholder organizations will be important to achieving the joint goals of improving the quality of health care and achieving vibrant and successful health care communities. TMF is excited about working with providers and stakeholders on CMS state and regional initiatives. 

The QIN-QIO role is to act as facilitator, convener, and quality improvement technical expert to support and enhance quality improvement efforts, spread quality improvement knowledge and expertise, and create an all-share, all-teach learning environment. TMF's goals are to achieve significant improvements in health care quality, to be a trusted partner in physician and stakeholder efforts to provide the highest quality and most efficient care to their patients, and to help participants become successful partners in value-based purchasing.

The five-year contract directs specific health care improvement initiatives to accomplish better care, better health for people and communities, and affordable care through improvements.

Initiatives include: 

  • 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/physician groups with value-based payment modifier;
  • Helping hospitals with performance improvement to enhance reimbursement to value-based payment;
  • Aiding other health care-related entities with alignment/linkages with other quality improvement programs and performance improvement;
  • Assisting hospitals with implementing quality improvement projects to improve performance on quality data reporting measures as needed; and
  • Helping communities improve the coordination of health care for patients to help reduce unnecessary hospital readmissions and improve medication safety by reducing adverse drug events. 

The TMF QIN-QIO will engage health care providers and stakeholders in the improvement initiatives through numerous learning and action networks (LANs). The networks are web-based opportunities to engage and share best practices through online forums as well as recorded and live webinars. The LANs also offer useful tools, resources, and the latest health care news. 

TMF encourages all interested providers and stakeholders to create an account online and take advantage of the wealth of information and educational events that will be available to support quality improvement efforts. The TMF QIN-QIO will offer targeted technical assistance to providers participating in the projects and will actively reach out and recruit physicians, nursing homes, home health agencies, and hospitals to participate over the next several months. 

If you would like more information or want to identify opportunities to participate, contact TMF; contact information is available on each network page, or you can submit a question to the QIN-QIO team.

To join the networks and learn more about each of the projects, visit the TMF QIN webpage and create an account. 

This Month in Texas Medicine

The October issue of Texas Medicine features a cover story on the 50th anniversary of the first surgeon general's report to link smoking to cancer. It examines the tobacco industry's marketing of new products to younger potential customers, and efforts from state and federal health organizations to make smoking a thing of the past. In the latest issue, you'll also find information on the new Institute of Medicine report on graduate medical education, a look at state health agencies under Sunset Commission review, a comparison of conflicting health insurance premium subsidy court rulings, a discussion of emerging trends in worksite primary care, and information on the TMF Health Quality Institute, Texas' quality improvement organization.

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.  

Extension to 2016 for Grandfathered Small Group Insurance Plans

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.  


Business Boot Camp: Take Charge of Your Finances 
10/16  Harlingen
10/21  Tyler
10/22  Dallas
10/23  Fort Worth
10/28  Lubbock
10/29  Amarillo
10/30  El Paso
11/3    San Antonio
11/4    Austin
11/5    Beaumont
11/11  Abilene
11/12  Wichita Falls

On-Demand Webinars

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

Physician Health and Wellness, ext. 1342

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

About Action       

 Action, the TMA newsletter, is emailed twice a month to bring you timely news and information that affects your practice

To change the email address where you receive Action, go to Member Log-In on the TMA website, then click on "Update Your TMA Demographic Information (including newsletter subscriptions and preferences)."

To unsubscribe from Action, email TMA's Communication Division at

If you have any technical difficulties in reading or receiving this message, please notify our managing editor, Shari Henson. Please send any other comments or suggestions you may have about the newsletter to Crystal Zuzek, Action editor.


Last Updated On

November 09, 2017