Action: April 15, 2015

TMA Action April 15, 2015   News and Insights from Texas Medical Association

INSIDE: Huge Victory for Medicine: No More SGR!

Huge Victory for Medicine: No More SGR!
Protect Yourself From Tax Fraud
Medicine's Bills Pick Up Speed
CMS Draft Rules Ease Meaningful Use Requirements
TMB Rules: Telemedicine Requires In-Person Exam First
CMS Open Payments Registration, Data Review Now Active
TMA and TOA: PROKERA Not for Optometrists
TMB Adopts New Medical Records Rules
DSHS, CDC Issue Listeria Testing, Medical Guidance

ACIP Recommends 9-Valent HPV Vaccine; New App Available
Register for TexMed 2015
Apply for the TMA Leadership College by July 1
CDC Reports Focus on Texas HPV Vaccination Data
Apply for a TMA Student Loan by May 31
Are You Game? A Lawn Party Features Activities for Everyone!
Take a Survey to Help Improve HPV Vaccination Rates in Texas
This Month in Texas Medicine

Huge Victory for Medicine: No More SGR!

Shout it from the rooftops: Success (finally)! Last night, medicine achieved the biggest victory since the passage of Texas' 2003 tort reform liability protections. Just hours before a 21-percent pay cut to physicians was set to take effect, the Senate approved the bill to repeal Medicare's fatally flawed Sustainable Growth Rate (SGR) formula, permanently and immediately. 

After 12 years and 17 temporary, cut-averting patches, both sides of the political aisle and both chambers of Congress worked together to pass the Medicare Access and CHIP Reauthorization Act, which was awaiting President Obama's signature early Wednesday morning.

TMA has been strongly advocating for repeal of the SGR for years. In a statement, TMA President Austin I. King, MD, extended his "sincere thanks to the United States Senate — especially our own Sen. John Cornyn — for taking this momentous step."

Indeed, the bill had support from Texas Senator Cornyn, who substantially helped get the bill across the finish line. U.S. Reps. Michael Burgess, MD, and Kevin Brady did some heavy lifting for years to see the bill through to passage. Senator Ted Cruz voted against the legislation.

"Eliminating the constant threat of Medicare payment cuts means that we can focus our energies on improving this new law. We can focus our energies on removing the bureaucratic impediments that get in the way of good patient care. We can focus our energies on enacting substantive and fundamental Medicare reforms that will help us provide lifesaving, life-sustaining, and life-enhancing care to our senior citizens, military families, and Texans with disabilities," Dr. King said, referring to the bill's passage as "13 very long and arduous years in the making." 

"I want to thank my predecessor TMA presidents who have kept the movement alive, the thousands of Texas physicians and patients who have visited and written and called their representatives and senators to demand repeal of the SGR formula, and the lawmakers who heeded our call. And the entire TMA family sends, in particular, a warm and most heartfelt appreciation to U.S. Reps. Michael Burgess, MD, and Kevin Brady and to Senator Cornyn. Their determination and grit over the past two years, obtaining bipartisan agreement on the policy, have made this day possible.”

The bill also contains provisions that protect state liability reforms and ensures the care standards and guidelines in the Affordable Care Act, Medicare, or Medicaid statutes can't be used to create new causes of legal action against physicians. U.S. Rep. Henry Cuellar (D-Texas) worked tirelessly to insert this language into the bill.

If you're a physician who participates in Medicare, you're probably wondering what this means for claims processing. The American Medical Association says Medicare should begin processing claims tomorrow for services provided in April at the rates that were effective before the 21-percent cut was to take effect. Under the provisions of the bill, the fee schedule conversion factor will increase by 0.5 percent on July 1, 2015, and by another 0.5 percent on Jan. 1, 2016.

The bill contains sweeping changes for how Medicare pays doctors. The bill directs the secretary of the U.S. Department of Health and Human Services "to establish a Merit-based Incentive Payment (MIP) system under which eligible professionals (including physicians, physician assistants, nurse practitioners, clinical nurse specialists, and certified registered nurse anesthetists) shall receive annual payment increases or decreases based on their performance." It also "requires specified incentive payments to eligible participants in an alternative payment model."

For more about the legislation, read this section-by-section bill analysis. The AMA has some helpful resources, including highlights from the bill and a chart comparing the new bill to current law.

Protect Yourself From Tax Fraud

TMA has heard from a handful of member physicians who recently discovered they're the victims of tax fraud. Unfortunately, this is nothing new. Last year, more than 100 TMA members notified the association someone had stolen their Social Security numbers and attempted to claim their tax refunds. The association learned the crime's victims also included physician assistants, advanced practice registered nurses, dentists, podiatrists, and pharmacists. 

Texas is one of 49 states and the District of Columbia affected by this con. So far, the perpetrators haven't been caught.

Please notify TMA if you have been a victim of tax fraud. The association can then convey the scope of the situation to the proper authorities. Contact the TMA Knowledge Center by telephone at (800) 880-7955 or by email.

With tax filing day upon us, it's never too late to take some preventive measures to avoid being a victim of fraud in the future. 

The Secret Service recommends all physicians, regardless of whether they have been victimized, visit and place themselves on a 90-day credit fraud alert. This could potentially slow or halt further attempted identity theft activities. While not every physician is at risk of identity theft, this is a suggested precautionary measure.

The American Medical Association offers the following guidance for physicians affected by this scam:   

  • File a paper return, and attach a Form 14039 Identity Theft Affidavit to explain what happened. 
  • Attach copies of the 5071C letter and any other notices from the Internal Revenue Service (IRS) to your tax return. If you have not received notice from the IRS but believe your personal information may have been used fraudulently, call the IRS Identity Protection Specialized Unit at (800) 908-4490.   

LifeLock is a TMA group discount program vendor that offers a suite of services to help protect against identity theft. TMA members receive a 20-percent discount. 

The North Carolina Medical Society suggests contacting the following agencies if you learn your Social Security number has been used fraudulently:   

  • File a complaint with the Federal Trade Commission (FTC), which recommends other immediate steps and provides helpful information on its website
  • File a local police report. Provide all documentation available, including any state and federal complaints you filed. This likely will be necessary if financial account fraud occurred as a result of the identity theft. If the fraud is solely tax-related, however, the police report will be necessary only if the IRS requests it. 
  • Call the Social Security Administration's (SSA's) fraud hotline at (800) 269-0271 to report fraudulent use of your Social Security number. In case your number is being used for fraudulent employment, you also can request your Personal Earnings and Benefit Estimate Statement on the SSA website or call (800) 772-1213. Check it for accuracy.
  • Consult the U.S. Department of Justice website for additional information on fraud and identity theft.  

The Federal Bureau of Investigation offers several steps you can take to make it harder for thieves to steal your personally identifiable information: 

  • Check your credit report regularly.
  • Don't carry around your Social Security card or any document containing your Social Security number.
  • Shred documents that contain sensitive information.
  • Only provide your personal information when absolutely necessary. Also, keep track of who has your information, as it could help determine the source of a breach if you become a victim of identity theft.
  • Use firewalls and antivirus software to protect your personal computers.
  • File your taxes as early as possible. Criminals file their fraudulent returns early to obtain refunds before the legitimate filer submits a return.
  • If you're not required to file a tax return, file one anyway to prevent someone else from filing a false return in your name and to be alerted in case someone has already filed a false return in your name.    

Medicine's Bills Pick Up Speed

With roughly six weeks to go in the Texas Legislature, lawmakers near the finish line in drafting a state budget for the next two years with significant improvements over last session that march the House of Medicine closer to accomplishing its goals. With House and Senate committees in full swing as well, TMA is tracking a plethora of bills on the move that could help or hurt medicine's agenda. 

"It's too early to determine bill outcomes. But there are some we like, some we don't, and some that are works in progress that we are pushing to good outcomes," TMA Vice President of Advocacy Darren Whitehurst said.

After a marathon session, the House approved its version of the state budget in April, wading through about 300 amendments. The Senate conversely approved its budget with no amendments earlier this week. The Senate and House will appoint conference committees to reconcile the differences between the two drafts. 

Despite some gaps between the two versions, TMA lobbyist Michelle Romero says each has its own strengths that increase spending in key TMA priority areas, and the final budget likely will settle in medicine's favor. 

The House and Senate budgets stand at roughly $210 billion for 2016-17, a nearly 2-percent increase over the current budget. House Bill 1 has more money for Medicaid and mental health; the Senate plan has more money for graduate medical education (GME) and women's health. 

The Senate budget puts $41 million into GME expansions, versus the House's $28.6 million. The vehicle to put the GME expansion money into action, Senate Bill 18, by Senate Finance Committee Chair Jane Nelson (R-Flower Mound), passed the Senate and heads to the House. Rep. John Zerwas, MD (R-Richmond), is expected to pick it up and sponsor a House version. The House and Senate budgets also boost formula funding for medical schools' teaching costs and for primary care programs, albeit at varying levels. 

In another preliminary win for medicine, the House Licensing and Administrative Procedures Committee passed a stand-alone bill by Rep. Drew Darby (R-San Angelo), House Bill 2089, to eliminate the $200-a-year occupations tax on physicians and other Texas professions. The measure was also folded into a separate bill, House Bill 7, which seeks to eliminate a number of budget gimmicks and ensure that dedicated funds are used for their intended purposes. 

The Senate budget does not, however, include the $460 million rider in the House to increase primary care physicians' Medicaid payments to Medicare rates. But Ms. Romero is optimistic there is opportunity to retain the money in the final version, and says, "In totality, both budgets do more for our issues over last session."

Lawmakers took one step closer to holding Medicaid HMOs more accountable for their network adequacy when Senate Bill 760 by Charles Schwertner, MD (R-Georgetown), cleared the Senate and heads to the House. 

Senator Juan "Chuy" Hinojosa's (D-McAllen) Senate Bill 207, which heads to a vote before the full Senate, sets clearer standards for Medicaid fraud investigations by the Office of Inspector General. It clarifies that a "credible allegation of fraud" does not include unintentional technical or clerical errors and requires "probable cause" for payment holds. 

Ms. Romero says, "It's a better standard that clarifies things for all parties involved: providers, the state, and SOAH (State Office of Administrative Hearings)," which oversees these cases. 

Red-Tape Reduction

But the red tape for physicians doesn't stop with the Medicaid program, and legislation to help physicians improve overall practice efficiency is moving along.

The House is poised to take action on Senate Bill 195 (by Senator Schwertner) after the Senate approved the move to shift the Prescription Drug Monitoring Program to the Texas State Board of Pharmacy from the Department of Public Safety (DPS). TMA also won a provision in the bill to eliminate the state Controlled Substances Registration permit physicians must get — in addition to their Drug Enforcement Administration license — to prescribe. Ongoing hang-ups in the state process — handled by DPS — have cost many physicians a temporary suspension of their hospital and prescribing privileges.

House Bill 1514 by Rep. J.D. Sheffield, DO (R-Gatesville), would help clear up some hassles for physicians dealing with health plans sold in the Affordable Care Act exchange. House Insurance Committee members took up the bill to require health plans to clearly identify exchange plans on members' identification cards with the letters "QHP" and whether that coverage is subsidized with the letters "QHPS." Under federal rules, if patients with subsidized exchange coverage default on their premiums for 90 days, health plans can recoup payments in the latter 60 days of that grace period. 

Consumer groups consider the labeling discriminatory toward patients of certain financial means. But TMA lobbyist Patricia Kolodzey says it's no different than patients carrying a card differentiating Medicaid coverage, and HB 1514 would do nothing to disclose patients' income status. Rather, the bill reduces the administrative burden on physician practices to discern patients' coverage, she says, and allows physicians to communicate with patients about the importance of paying their premiums and to plan treatment accordingly, particularly long-term treatment.

TMA also supports House Bill 1624 by Rep. John Smithee (R-Amarillo) to require health plans to publicly display their network directories and drug formularies on their websites for physicians and patients to check. 

"The Flood Gates Are Open"   

With committee hearings fully under way, "the flood gates have opened," as TMA lobbyist Dan Finch puts it, and TMA continues to pour over bill filings, amendments, substitutions, and testimony that could undermine medicine's agenda.  

As House Insurance Committee hearings went into the wee hours of the morning, TMA physicians testified against an attempt to ban balance billing for emergency care under House Bill 1638 (by Representative Smithee). As filed, the bill would send physicians and health plans to arbitration over costs not covered under patients' insurance. A battle is under way, too, to preserve existing avenues available to patients to resolve billing disputes through mediation. House Bill 3133 (also by Representative Smithee) eliminates the current $1,000 threshold for patients to take balance bills from facility-based physicians to mediation, which could make the process costly for physicians.

TMA physicians testified against any prohibition on balance billing for out-of-network services and emphasized that patients must continue to be the initiators of any requested mediation.

TMA also opposed House Bill 3102 by Rep. John Frullo (R-Lubbock), which, as filed, requires physicians to adhere to a binding quote provided three days in advance of any services and forfeit any additional amounts doctors incur for unanticipated services. 

At hearings, Representatives Smithee and Frullo both indicated their bills were a work in progress, Ms. Kolodzey says, and substitute bills were forthcoming. Stay tuned!

That same committee also took up two telemedicine bills — one good for medicine, one bad.

Raising alarm bells, House Bill 2172 (by Representative Smithee) would skirt current Texas Medical Board regulations and permit physicians to diagnose over the telephone without an initial face-to-face visit to establish a patient-physician relationship. On the other hand, TMA is backing a measure — House Bill 2348 by Rep. Four Price (R-Amarillo) — to ensure physicians get paid fairly for services like after-hours phone or telemedical consults by requiring health plans to pay local doctors the same as they would if hiring outside telemedicine vendors for those services.  

On the scope-of-practice front, TMA continues to put out fires. 

The House Public Health Committee took up House Bill 1263 by Rep. Richard Raymond (D-Laredo) allowing physical therapists to directly treat patients without first seeking a diagnosis and referral from a physician. Also on the committee agenda, House Bill 2602 by Rep. Garnet Coleman (D-Houston) would allow optometrists, advanced practice registered nurses, and physician assistants more leeway to prescribe Schedule 2 drugs under delegation by a physician. 

Progress on Public Health

Meanwhile, medicine saw progress on a couple of packages of TMA-backed legislation on public health and end-of-life issues.     

The House Public Health Committee voted out a pair of vaccination bills by Representative Sheffield. One changes requirements under the state's immunization registry, ImmTrac, to store childhood vaccination records until age 26 instead of age 18 and ensure they are available past college and into early adulthood. A second bill gives parents the right to know the number of students in their child's school who have opted out of vaccinations.    

TMA worked to improve bill language before the Senate's approval of Senator Schwertner's bill, Senate Bill 538, to overhaul and coordinate local and state management of infectious disease emergencies. The Senate Education Committee, meanwhile, approved Senator Hinojosa's bill, Senate Bill 66, requiring schools to stock auto-injectors in schools. At press time, a House hearing was not far behind.     

Hearings got under way on legislation tackling end-of-life issues debated for many a session. 

As TMA keeps an eye out for threats to physicians' moral conscience and professional ethics, a pair of bills medicine supports got airtime before the House State Affairs Committee: House Bill 2351 by Rep. Patricia Harless (R-Spring) would require hospital ethics committees to adopt a nondiscrimination policy, and House Bill 3074 by Rep. Drew Springer (R-Muenster) classifies artificial nutrition and hydration as ordinary, not extraordinary, care.  

Even though the legislature is picking up speed, it's not too late to keep up through the TMA Legislative News Hotline or to make a final push for medicine in person at TMA's First Tuesdays at the Capitol. The last lobbying event is May 5. Register now!

Amy Lynn Sorrel, associate editor of Texas Medicine, prepared this special supplement to Action. 

CMS Draft Rules Ease Meaningful Use Requirements

Meeting meaningful use criteria may get a little easier for physicians if the Centers for Medicare & Medicaid Services (CMS) adopts draft rules that propose to standardize the 2015 reporting period for the electronic health record (EHR) incentive program to 90 consecutive days.  

The rules would also require only one patient in a physician's practice to use technology to download, view, and transmit his or her medical records. Currently, meaningful use requires 5 percent of patients in a practice to participate in the electronic exchange of their records.

TMA's advocacy efforts have focused on expanding adoption of health information technology among physicians while ensuring the exchange of secure and interoperable health information.

In a letter to Karen B. DeSalvo, MD, national coordinator for health information technology, Matt Murray, MD, asks the Office of the National Coordinator (ONC) to "carefully consider marketplace readiness during rulemaking."

"Physicians are feeling crushed by increasing regulatory demands, especially with the meaningful use requirements. Physicians are in a precarious position: We are required to comply with overly burdensome requirements that are simply not supported by current health technology," wrote Dr. Murray, chair of the TMA Ad Hoc Committee on Health Information Technology.

He tells ONC that electronic health records (EHRs) lack any safety components without usability, interoperability, and standardization.

TMA has a new tool to help physicians meet Stage 2 meaningful use criteria. The currently toolkit features two EHR vendors — e-MDs and NextGen. Each vendor provides detailed instructions and screenshots for each measure. Even if you don't use these vendors, you may find it helpful to see how other EHRs track the measures.  

Physicians who began participation in the EHR incentive program in 2011 should have met three consecutive years of meaningful use under the Stage 1 criteria before advancing to the Stage 2 criteria in 2014. All other physicians must meet two years of meaningful use under the Stage 1 criteria before advancing to the Stage 2 criteria in their third year.

If you are still participating in Stage 1, be sure to reference the Stage 1 Toolkit, which includes information from five EHR vendors.

For questions about the incentive program and other health information technology needs, contact TMA's Department of Health Information Technology at (800) 880-5720 or by email.  

TMB Rules: Telemedicine Requires In-Person Exam First

Texas Medical Board (TMB) rules adopted last week send a message that technology is no substitute for physical patient exams. By voting to require physicians to conduct a face-to-face examination before making a diagnosis or prescribing drugs, TMB took a big step to protect patients who receive telemedicine services. 

TMB has been examining the practice of telemedicine for years and is involved in a lawsuit with Dallas-based company Teladoc.  

In a comment letter TMA sent to TMB on the proposed rules, the association states that it "supports the use of telemedicine that can provide safe, high-quality, timely care to patients, particularly in areas of the state that have critical physician shortages. However, TMA believes that Texas must maintain appropriate safeguards to protect patients and ensure telemedicine complements the efforts of local health care providers."

According to the rules, physicians can see a patient via telemedicine for the first time — without a prior in-person visit — if the patient is at a location that allows a physician to adequately examine and communicate with the patient in real time with the assistance of technology and a patient site presenter. The new telemedicine rules also permit mental health services to be provided at a patient's home, including residential treatment facilities, nursing homes, jails, detention centers, and assisted living centers, through real-time audio and video technology. 

Despite claims to the contrary from critics, the changes do not and are not intended to interfere with traditional on-call coverage arrangements, based on the board’s discussion during its April 9 meeting.

Barring a court challenge and subject to any changes during the legislative session, the rules take effect June 3. 

 TMLT Action Ad 4.13   

CMS Open Payments Registration, Data Review Now Active

The Centers for Medicare and Medicaid Services (CMS) developed the Open Payments Program to comply with the Physician Payments Sunshine Act, which requires CMS to publicly report data on items of value given annually to physicians and teaching hospitals.  

Physicians could begin registering in the Open Payments System and reviewing their 2014 calendar year data on April 6. The official 45-day review-and-dispute period runs from April 6 to May 20. Disputes initiated by May 20 will be flagged in the public release on June 30.

The American Medical Association website has step-by-step instructions on how to register and review Open Payments data.  

You can share your registration experience with AMA by emailing Responses will be used in AMA's ongoing advocacy efforts.  

TMA and TOA: PROKERA Not for Optometrists

TMA and the Texas Ophthalmological Association (TOA) sent a comment letter to the Texas Optometry Board strongly objecting to a proposed rule concerning procedures authorized for therapeutic optometrists. 

The proposed rule, published in the March 20 edition of the Texas Register, would allow a therapeutic optometrist to "administer, perform, or prescribe ophthalmic devices, procedures, and appropriate medications administered by topical means, to diagnose or treat visual defects, abnormal conditions, or diseases of the human vision system, including the eye and adnexa."

In the letter, the organizations state their concern that use of an ocular medical device such as PROKERA is beyond the scope of practice for optometrists in Texas. TMA and TOA say use of PROKERA by optometrists would not fall under Texas' optometric scope-of-practice statute, which authorizes optometrists to prescribe lenses, contact lenses, and ocular pharmaceutical agents.

"Inaccurately classifying PROKERA® within one of those categories minimizes both the significance of the device, and more concerning, for safety, the severity of the patient’s condition requiring use of the device. PROKERA® is a medical device intended for use in the closure of human tissue, which is specifically prohibited by Texas statute," wrote Austin I. King, MD, TMA president.

Visit the TMA website for more about TMA's current scope-of-practice issues.

TMB Adopts New Medical Records Rules

Some of the most common, yet vexing, legal issues facing medical practices involve questions about medical records. Maintaining adequate patient records that adhere to legal requirements is vital.

The Texas Medical Board (TMB) last week adopted a proposed rule that attempts to clarify the minimum standards for maintaining an adequate medical record, when communication with physicians outside the office setting (such as texts and emails) regarding a patient should be reflected in the medical record, and that prepopulated fields in electronic health records (EHRs) implying tests were performed must contain accurate data.

Last year, TMA requested formation of a stakeholder group to provide input on the implication of proposed medical records rules and alternatives to address problems with EHRs identified by TMB. The group met last August and included physicians from different specialties, geographic locations, and practice settings, as well as experts from the EHR industry and other state agencies. 

In a comment letter on the proposed rules to TMB, TMA said "many of the concerns identified, and suggestions offered, in that meeting led to an improved [rule]."

The adopted rule reflects language suggested by the stakeholder group and states that an adequate medical record should "include a summary or documentation memorializing communications transmitted or received by the physician about which a medical decision is made regarding the patient."

The association's concerns with the language of the proposed rule related to the issue of prepopulated data in an EHR. 

TMA wrote, "Perhaps the biggest potential source of confusion for physicians regarding this proposed rule, however, is the use of the phrase, 'non-biographical populated fields.' TMA believes the use of this phrase is recognition by the TMB that many electronic medical record vendors' products contain a feature that copies particular data and places it on each page of an electronic medical record (usually fields such as patient name, date of birth, patient number). Regardless of whether that interpretation is correct or not, TMA suggests that the phrase either be changed, clarified or defined so that physicians interpret the rule in the manner intended by TMB."

TMA recommended the following language: "All populated fields containing clinical information within a patient's electronic medical record must contain accurate data and information pertaining to the patient based on actual findings, assessments, evaluations, diagnostics or assessments as documented by the physician."

Despite TMA's suggestions, TMB adopted the rule as proposed. TMB will, however, take TMA's suggestion to create and publish a list of frequently asked questions addressing questions physicians may have regarding the adopted rules, particularly as they relate to which fields are, or are not, "non-biographical populated fields."

DSHS, CDC Issue Listeria Testing, Medical Guidance

The recent Listeria outbreak linked to Blue Bell Ice Cream prompted the Texas Department of State Health Services (DSHS) to issue a health advisory that recommends testing patients who have fever and other symptoms consistent with listeriosis, are at increased risk of invasive listeriosis, and may have been exposed to Listeria through a potentially contaminated product.

The Centers for Disease Control and Prevention (CDC) reports three cases of listeriosis have been identified in Texas as part of the outbreak, related to products made at Blue Bell's Oklahoma plant. The Texas patients were hospitalized for unrelated problems before they developed listeriosis between 2011 and 2014. One additional patient from Texas with listeriosis in 2010 has been identified, and whole genome sequencing testing is under way to determine whether the case is related to this outbreak.

Physicians and other health care professionals can also access the CDC’s guidance document, "Suggested framework for medical management of people at elevated risk for invasive listeriosis who are exposed to Listeria monocytogenes." 

DSHS says diagnostic testing should include cultures of blood and other specimens, such as cerebrospinal fluid, as indicated by the clinical presentation. People at high risk for invasive listeriosis include: 

  • Pregnant women, 
  • Adults 65 and older, and 
  • People with weakened immune systems.  

According to DSHS, the incubation period for invasive Listeria infection is typically a few days to one month but can be up to 70 days. Symptoms may include fever and muscle aches, sometimes preceded by diarrhea and other gastrointestinal symptoms.

DSHS urges health care professionals and laboratories to promptly report confirmed listeriosis cases to their local health department or DSHS, which can be reached by phone at (800) 705-8868 or by fax at (512) 776-7616. All Listeria monocytogenes isolates should be sent to the DSHS laboratory.

Anyone who has consumed any recalled Blue Bell Creameries products is at risk of exposure. Exact product descriptions and codes for recalled products can be found on Blue Bell's consumer information website 

TMAIT Action Ad Sept 14

ACIP Recommends 9-Valent HPV Vaccine; New App Available

In February, the Advisory Committee on Immunization Practices (ACIP) recommended nonavalent human papillomavirus (HPV) vaccine as one of three HPV vaccines that can be used for routine vaccination in men and women. ACIP recommends routine HPV vaccination begin at age 11 or 12. The vaccination series can be started as early as age 9. 

ACIP also recommends vaccination for females aged 13 to 26 and for males aged 13 through 21 who have not been vaccinated previously or who have not completed the three-dose series. Males aged 22 to 26 may be vaccinated.

According to ACIP, the bivalent, quadrivalent, and nonavalent vaccines all protect against HPV 16 and 18, types that cause about 66 percent of cervical cancers and the majority of other HPV-attributable cancers in the United States. The nonavalent vaccine targets five additional cancer-causing types, which account for about 15 percent of cervical cancers. The quadrivalent and nonavalent vaccines also protect against two types of the disease that cause anogenital warts.

Meanwhile, the 2015 child and adolescent immunization schedule and adult immunization schedule have been released. 

Health care professionals who recommend or administer vaccines can access all 2015 CDC-recommended immunization schedules and footnotes using the CDC Vaccine Schedules app. Optimized for tablets and useful on smartphones, the app shows the child, adolescent, and adult vaccines recommended by ACIP. 

  • If you previously downloaded the 2014 app, you must download the 2015 version, release 2.0.1. Check your app store or app library for updates.
  • If you are new to the free Vaccine Schedules app, see instructions on downloading to iOS and Android devices.   

Register for TexMed 2015

Register today for TMA's free annual conference, and join thousands of your fellow Texas physicians, as TexMed 2015 arrives in Austin May 1-2 for a weekend of advocacy, education, and collaboration. 

TexMed is TMA's largest event of the year, offering free continuing medical education (CME), an extensive gathering of exhibitors to help with every aspect of your practice, and, because we're in Austin, a special Thursday event at the Capitol. See all the details and register online.

At TexMed 2015, you can meet with elected officials face-to-face to voice the priorities for medicine this legislative session, participate in your choice of more than 80 hours of free CME including two general sessions, and mingle and network with your colleagues from across the state. There's nothing quite as impactful as thousands of Texas physicians coming together in one place to form one unified voice.

The latest in your colleague's quality improvement initiatives will be on display during the third annual TexMed Poster Session — an author-hosted walk-through on Saturday from 8 am to 9 am. Categories have been expanded this year to offer physicians and medical practice staff more opportunities to participate. For additional information or to submit your own application to participate, visit the poster session webpage.

The TMA group block at the Hilton Austin has sold out. Additional guest rooms have been reserved at the Hilton Garden Inn Austin Downtown. Reservations at the Hilton Garden Inn must be made by phone, (877) 782-9444, or email.

For a full schedule of events, CME, exhibitors, lodging information, fun things to do in and around Austin, and how to get more involved in TMA policy creation, visit the TMA website

Apply for the TMA Leadership College by July 1

TMA is now accepting applications for the TMA Leadership College Class of 2015. The deadline to apply is July 1.

The TMA Leadership College, established in 2010 as part of TMA's effort to ensure strong and sustainable physician leadership within organized medicine, is geared toward active TMA members younger than 40 or who are in the first eight years of practice.

Graduates serve as thought leaders who can close the divide between clinicians and health care policymakers and as trusted leaders within their local communities. Many also receive priority consideration for appointment to TMA councils and committees.

Visit the TMA webpage for full program details, a class schedule, and application.

For more information, contact Christina Shepherd in the TMA Membership Development Department by email or by calling (800) 880-1300, ext. 1443, or (512) 370-1443.

CDC Reports Focus on Texas HPV Vaccination Data

Did you know that in 2013, 85 percent of Texas girls who were unvaccinated against human papillomavirus (HPV) had a missed opportunity for HPV vaccination? And 93 percent of Texas girls could have started the HPV vaccine series if missed opportunities were eliminated. You'll find this and other insightful Texas-specific data in the Centers for Disease Control and Prevention's (CDC's) quarterly HPV vaccination reports.

CDC hopes that highlighting Texas-specific data will help immunization stakeholders and physicians develop strategies that increase HPV vaccination rates. The first quarter report focuses on key recommendations for preventing missed HPV vaccination opportunities in Texas. The second quarter report focuses on the importance of the clinician recommendation for HPV vaccination.   

Watch your inbox for information in Action about future HPV vaccination reports.    

PC Action Ad Sept 13     

Apply for a TMA Student Loan by May 31

Need help funding your medical school education? Consider TMA's educational loan program. TMA offers $4,000 student loans for Texas medical students at a fixed interest rate of 4.4 percent. 

If you are interested, contact your school’s financial aid office to request an application. The 2014-15 school year deadline for disbursement is May 31. 

Call (800) 880-2828 to speak with a TMA representative regarding the loan program. Visit the TMA website for more information.

Are You Game? A Lawn Party Features Activities for Everyone!

Is your interest piqued? A Lawn Party is the TMA Foundation's 22nd annual benefit gala on May 1 at the Hilton Austin, and it will surely be the most talked about event in 2015. 

In addition to VIP and general guest tickets, tables of eight also are available to enjoy with friends and colleagues at this stylish backyard-inspired party. 

Be there at A Lawn Party and: 

  • Outbid your friends on live auction packages including a special Omni Barton Creek Resort and Spa vacation or a Hill Country hunting weekend at the T-Bar-O Ranch in Kingsland.
  • See who's tops in life-sized Jenga® and other lawn games.
  • Use your Smartphone to bid on an American Sniper movie poster signed by the cast, vacation packages including Disneyland, tickets to the 2016 NCAA College Basketball Final Four tournament in Houston, a stay at Moody Gardens Resort, and more.  

For more information and to purchase tickets, contact TMA Foundation at (800) 880-1300, ext. 1664, or (512) 370-1664, or visit the TMA Foundation webpage

Take a Survey to Help Improve HPV Vaccination Rates in Texas

The MD Anderson Cancer Center 2015 Survey for Improving Pediatric HPV Vaccination Rates in Texas will identify barriers and facilitators to increasing human papillomavirus (HPV) vaccination rates in Texas children. 

Survey responses are confidential and anonymous.

This Month in Texas Medicine

The April issue of Texas Medicine guides you through the what, when, why, and how behind Medicare value-based care; examines the educational and workforce benefits of resident moonlighting; discusses a Texas court case in which the telehealth provider Teladoc argues that a face-to-face meeting is unnecessary for new patients; explains the proposed health service enterprise gateway, which would connect to local health information exchanges and give physicians a single place to exchange data with all state health agencies; and introduces Ira Byock, MD, who will speak at TexMed's General Session in May about providing the best care possible at the end of life. 

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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.  

Deadline to Register to Participate in GPRO for the 2015 PQRS Program Year

ICD-10 Implementation Compliance   

First-Year Participants' Last Day to Begin 90-day Reporting Period of Meaningful Use for the 2015 Medicare and Medicaid EHR Incentive Programs

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.  


Commit to Compliance: Meeting the Challenge: May 8

On-Demand Webinars

Prompt Pay and the Revenue Cycle
How to Talk to Patients About Tobacco Cessation
10 Ways to Turn Satisfied Patients Into Loyal Patients 

Conferences and Events

TexMed 2014
May 1-2

About Action       

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

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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

December 20, 2016