Action: Jan. 5, 2016

TMA Action Jan. 5, 2016   News and Insights from Texas Medical Association

Doctors Can Prohibit Handguns in Medical Offices
New Year, Big Savings: Save 20 Percent on CME
Congress Expedites 2015 Meaningful Use Stage 2 Exemptions
Teladoc's Antitrust Suit Against TMB Moves Forward
EPCS Permitted in Texas
Take Action to Avoid a Medicare Meaningful Use Penalty
Physicians: Reenroll in Medicaid by March 24, 2016
Don't Miss the 2016 TMA Winter Conference Jan. 29–30
Doctor's Recommendation Key in HPV Vaccination
TMA Accountable Care Leadership Program Enrolling for 2016
TMF Helps With Value-Based Improvement, Outcomes
Participate in the Texas Two Step Mass CPR Event
TMA's Newest Group Discount Program Vendor: EnviroMerica
Last Call: TMA Anson Jones, MD, Awards
Free PDR App Puts Latest Drug Information at Your Fingertips

Doctors Can Prohibit Handguns in Medical Offices

If you're not exactly jazzed about the thought of patients carrying handguns into your medical practice, you can do something to prevent it. House Bill 910 by Rep. Larry Phillips (R-Sherman) goes into effect Jan. 1, 2016, and it allows Texans with handgun licenses to openly carry their handguns in a hip or shoulder holster. TMA has received questions regarding whether physicians can post a notice at their practices prohibiting anyone from entering with a handgun — concealed or openly. The answer depends on the type of property the medical office is located on. Generally, a private property owner may post a notice prohibiting the carrying of handguns, but HB 910 contains many requirements. TMA's white paper, "Prohibiting Concealed or Open Carry Handguns on Private Property," has more information for physicians.

HB 910 generally authorizes the open carry of handguns (in a shoulder or belt holster) in Texas by anyone with a handgun license. There are exceptions to this — found in Texas Penal Code §46.03 and 46.035 — including schools, school vehicles, polling places, courts, racetracks, airports, bars, sporting events, amusement parks, churches, nursing homes, and most hospitals (unless the license holder has written authorization  from the hospital or nursing home administration).

Private property owners may prohibit the open carry of handguns orally, with a card or other document, or by posting a sign that reads "Pursuant to Section 30.07, Penal Code (trespass by license holder with an openly carried handgun), a person licensed under Subchapter H, Chapter 411, Government Code (handgun licensing law), may not enter this property with a handgun that is carried openly" in both English and Spanish in contrasting colors with block letters at least one inch in height, clearly visible to the public at entrances to the property.

Also, on Jan. 1, 2016, the language for a sign prohibiting people from carrying a concealed handgun changes. As of that date, the sign must say, "Pursuant to Section 30.06, Penal Code (trespass by license holder with a concealed handgun), a person licensed under Subchapter H, Chapter 411, Government Code (handgun licensing law), may not enter this property with a concealed handgun."    

Please note: Section 30.07 of the Penal Code relating to the open carry of handguns requires a sign "at each entrance to the property," while Section 30.06 relating to the concealed carry of handguns only requires a sign "displayed in a conspicuous manner clearly visible to the public."

A common question is whether private property owners will need two signs to cover both the concealed and open carry of handguns, or if one will suffice. The law indicates the language required by the Penal Code may not be altered or combined into one paragraph or sentence. The language must be identical to that in the statute for a private property owner to rely on it as the means for providing notice to handgun license holders.

New Year, Big Savings: Save 20 Percent on CME

The New Year is here, and it's the perfect time to visit the TMA Education Center. This month, TMA is offering an additional 20 percent off our already discounted member pricing for continuing medical education. 

This sale price includes publications, on-demand webinars, and podcasts. The discount doesn't apply to live CME programming. 

Dozens of courses are on sale, including popular programs covering ethics, risk management, compliance, and practice operations. Visit the TMA Education Center, and enter coupon code NEWYEAR20 at checkout to start saving. The sale ends Jan. 31.

Congress Expedites 2015 Meaningful Use Stage 2 Exemptions

In December, Congress adopted S 2425, known as the Patient Access and Medicare Protection Act, which included a provision granting the Centers for Medicare & Medicaid Services (CMS) the authority to expedite applications for exemptions from meaningful use Stage 2 requirements for the 2015 calendar year.

To avoid a penalty under the meaningful use program, eligible professionals must attest that they met the requirements for meaningful use Stage 2 for a period of 90 consecutive days during calendar year 2015. 

CMS did not publish the modification rule for Stage 2 meaningful use until Oct. 16, 2015. As a result, eligible professionals weren't informed of the revised program requirements until fewer than the 90 required days remained in the calendar year. 

CMS has previously stated that it will grant hardship exemptions for 2015 if eligible providers are unable to attest due to the lateness of the rule. But under current law, CMS can  grant such exemptions only on a case-by-case basis. This means that many physicians will be required to apply for exemptions and that CMS will have to act on each application individually.

A provision of the legislation adopted by Congress would grant CMS the authority to process requests for hardship exemptions to physicians through a more streamlined process, alleviating burdensome administrative problems for doctors and the agency. 

Teladoc's Antitrust Suit Against TMB Moves Forward

Teladoc's lawsuit against the Texas Medical Board (TMB) is heating up. On Dec. 14, U.S. District Judge Robert L. Pitman refused to dismiss telemedicine provider Teladoc Inc.'s antitrust challenge of TMB's rule requiring, in most circumstances, a defined physician-patient relationship (including a physical examination either in person or face-to-face via telemedicine with a presenter) before prescribing a dangerous drug or a controlled substance. 

The judge found that TMB cannot claim sovereign immunity from antitrust liability as an agent of the state because the state of Texas "lacks sufficient control" over the regulatory board composed of the licensees it regulates.

In its motion to dismiss the case, the state argued that oversight of TMB provided by Texas' courts, the State Office of Administrative Hearings, the governor (by appointing TMB members), and the Texas Legislature were sufficient to meet the "active supervision" requirement of the state action immunity doctrine and that it should be given sovereign immunity from Teladoc's antitrust challenge of the board's regulatory action. In his order, Judge Pitman rejected this argument. 

The Teladoc challenge came on the heels of a decision from the U.S. Supreme Court last year. The Supreme Court ruled that the North Carolina State Board of Dental Examiners violated federal antitrust laws by preventing non-dentists from providing teeth-whitening services in competition with the state's licensed dentists. The Federal Trade Commission (FTC) had challenged the board’s authority to act as a state agency with "state action immunity" from federal antitrust laws. FTC argued (and the Supreme Court agreed) that the board, elected by the licensed dentists in North Carolina, was considered to be a private entity subject to antitrust scrutiny. The court also agreed with the FTC argument that the fact that the licensees subject to the board's authority composed a majority of the regulatory board was further evidence that the state was not sufficiently supervising the board's actions. This was enough for the dental board to be considered a private entity for purpose of antitrust scrutiny.

Since the Supreme Court's decision on the North Carolina case, FTC developed "Staff Guidance on Active Supervision of State Regulatory Boards Controlled by Market Participants." (Note that the adherence to the FTC Staff Guidance is not necessarily required to qualify for state action immunity).* 

In its guidance, FTC states, "Federal antitrust law does not require that a state legislature provide for active supervision of any state regulatory board. A state legislature may, and generally should, prefer that a regulatory board be subject to the requirements of the federal antitrust laws. If the state legislature determines that a regulatory board should be subject to antitrust oversight, then the state legislature need not provide for active supervision."

The Teladoc case against TMB will continue to move forward. The denial of TMB's motion to dismiss does not necessarily mean that a violation of antitrust law has occurred. It only means that the state action immunity defense has been rejected. 

This issue is on the TMA 2015 Winter Conference program Saturday morning, Jan. 30, at the Hyatt Regency Austin. The Texas Sunset Review Commission's review of health-related licensure boards, including TMB, also is in play. The Sunset Advisory Commission's report will be provided to the Texas Legislature meeting in 2017. These developments will affect licensing board composition, operations, and oversights in the future. 

* Note the following limitation on the guidance, as stated in the document: "This document contains guidance developed by the staff of the Federal Trade Commission. Deviation from this guidance does not necessarily mean that the state action defense is inapplicable, or that a violation of the antitrust laws has occurred."    

Action TMLT Ad 10.15

EPCS Permitted in Texas

The start of the New Year is a good time to remind you of a Texas law that permits physicians to electronically prescribe controlled substances. If you regularly write prescriptions for controlled substances, you may find value in upgrading your technology to comply with the federal and state regulations

Electronic prescription of controlled substances (EPCS) is a more secure form of prescription delivery and can help reduce controlled substance abuse caused by stolen prescription forms. EPCS differs from regular e-prescribing in that a physician must undergo an authentication process before using the technology and when ordering each EPCS. Authentication involves the physician providing a PIN number, an iris scan or thumb print, or using a device or card. Physicians can delegate EPCS or EPCS renewals to other clinical staff for order entry, but physicians must enter the order themselves. For more about EPCS, read "A Necessary Pain" in the July 2014 issue of Texas Medicine.  

More than 80 percent of pharmacies in Texas are now enabled to accept EPCS, but to reduce rejections, physicians should notify pharmacies in their area when they begin using EPCS. Physicians interested in learning more may contact TMA's Health Information Technology Department by calling (800) 880-5720 or by email.

Take Action to Avoid a Medicare Meaningful Use Penalty

While Medicaid does not penalize physicians who are not meaningful users of their electronic health record (EHR), Medicare does.  

Physicians participating in the Medicaid meaningful use program must prove 30-percent volume of Medicaid encounters each year to continue participation, and through Medicaid participation, physicians avoid a penalty on their Medicare allowable charges. The meaningful use program allowed physicians to switch between the Medicare and Medicaid meaningful use program one time before 2014. There are steps physicians need to take if they're no longer eligible for Medicaid meaningful use but need to take action to prevent a Medicare penalty. 

The Centers for Medicare & Medicaid Services (CMS) has an alternate attestation method for physicians who can't qualify for a Medicaid payment and who can't switch back to Medicare, but who still need to attest to meaningful use to avoid the Medicare penalties. Last year, CMS had a paper form to accomplish this. For the 2015 payment year, it will be through the CMS Medicare attestation portal

The CMS portal is available for modified Stage 2 meaningful use attestations as of Jan. 4, and physicians have until Feb. 29, 2016, to complete their attestations. TMA recommends you not wait until the last minute in case system problems arise.    

For questions on meaningful use or other practice technologies, contact TMA's Health Information Technology Department by email or by calling (800) 880-5720. 

Physicians: Reenroll in Medicaid by March 24, 2016

The Affordable Care Act requires all Medicaid health professionals to reenroll in the program at least once every five years (some professionals must reenroll more frequently). Physicians are next on the list and must reenroll by March 24, 2016. However, if you initially enrolled or reenrolled on or after Jan. 1, 2013, you will be required to reenroll by the date indicated on your enrollment letter.

The Texas Health and Human Services Commission and the Texas Medicaid and Healthcare Partnership (TMHP) have improved the electronic enrollment portal to make it easier for doctors to complete the reenrollment process. (Physicians newly enrolling in Medicaid can also use the portal.) The enhancements apply to applications submitted through the TMHP website on or after April 26, 2015.

The improved electronic application process allows you to:

  • Upload supporting documentation;
  • Sign the enrollment agreement electronically (e-sign);
  • Receive guidance as you work on the application and see more accurate error messages to avoid mistakes;
  • Receive instruction on how to upload documents and submit the application using an e-signature; and 
  • Expedite processing of your application by reducing the need for printing and mailing documents. 

For physicians currently enrolled in Medicaid, the portal will pre-populate the application with demographic data pulled from the physician’s current account.

To be considered fully reenrolled by the March 24, 2016, deadline, physicians must receive verification from TMHP that the application has been approved before that date. It currently takes about 32 days for applications to be processed. Thus, physicians should reenroll early to avoid gaps in enrollment. The reenrollment requirement also applies to physician assistants and advanced practice registered nurses.

To use the online application, you must have a TMHP user account and a user name (portal user ID). Refer to the TMHP Website Security Provider Training Manual for instructions on activating a TMHP user account. For more information about Medicaid provider reenrollment, visit the TMHP provider reenrollment page.

Don't Miss the 2016 TMA Winter Conference Jan. 29–30

Don't miss the 2016 TMA Winter Conference, Jan. 29–30 at the Hyatt Regency in Austin. Register for the conference now. Reserve your hotel room at the Hyatt Regency Austin by Jan. 7 to get the room rate of $199 plus tax.

Visit the TMA website for more information about the winter conference, which will include a discussion on the Teladoc v. TMB lawsuit by attorney Jack R. Bierig on Saturday, Jan. 30. Saturday's General Session programming will feature TMA Foundation awards; opening remarks by TMA President Tom Garcia, MD; an update on the American Medical Association from AMA President Steven J. Stack, MD; a discussion of demographic changes affecting Texas by Rep. Larry Gonzales (R-Round Rock); and a presentation on the future of technology in medicine by Nick van Terheyden, MD, Dell health care and life sciences chief medical officer.     

TMAIT Action Ad 6.15

Doctor's Recommendation Key in HPV Vaccination

When it comes to human papillomavirus (HPV) vaccination among children and adolescents, a physician's recommendation really does make a difference. That's according to The University of Texas MD Anderson Cancer Center's detailed assessment, or "environmental scan," of HPV vaccination in Texas pediatric care settings. 

According to 2014 National Immunization Survey-Teen data, national rates for HPV vaccine series completion in 2014 were 39.7 percent for girls and 21.6 percent for boys. Estimated Texas rates were 33.9 percent for girls, down from the 2013 rate of 38.9 percent. Rates for boys in Texas increased slightly, from 15 percent in 2013 to 17.7 percent in 2014. The report shows the rates of boys and girls who received at least one dose of HPV vaccine were higher among those who received a recommendation from a physician or other health care professional than among those who did not: 69.7 percent vs. 38.3 percent of girls and 63.5 percent vs. 20.1 percent of boys, respectively.

TMA helped facilitate the HPV Vaccine Uptake in Texas Pediatric Care Settings: 2014-2015 Environmental Scan Report, funded by a grant from the National Cancer Institute, by distributing a physician survey through this newsletter in 2015. The project complements the TMA Committee on Cancer's efforts to promote HPV vaccination. Lois Ramondetta, MD, chair of the committee, led the scan project. The report provides an overview of HPV-related cancer burden in Texas and identifies barriers to and facilitators of HPV vaccination in the pediatric population.

Key components of the environmental scan included assessment of vaccination-delivery methods, settings such as school-based vaccination access, the role of nurses and mobile delivery approaches, immunization coalitions, public health personnel, and research studies in progress. The report also focused on HPV vaccination attitudes, knowledge, and trends in underserved populations.

TMA Accountable Care Leadership Program Enrolling for 2016

Are you ready to lead in the new health care landscape? TMA is now accepting applications for the 2016 Accountable Care Leadership Program. Applications are due Jan. 15. View the sample curriculum, get more information, or apply on the TMA website. 

The program, which graduated its inaugural class in November, helps ensure physicians are leading the charge in health care transformation. TMA launched the program hand in hand with TMA PracticeEdge, a physician services organization designed to support physicians in taking advantage of new payment models. 

Participants in the 10-month certificate program learn topics like communication skills, teamwork, and population health management, meant to help physicians adapt in a rapidly changing environment that demands more accountability and proof of value for the health care dollar. Physicians can access lectures, readings, quizzes, and case studies 24/7, putting in an estimated 10 hours of homework every three weeks. Participants also take part in two in-person TMA-hosted sessions — a program kickoff and a capstone to conclude the program.

The curriculum, developed and administered by the University of Texas at Dallas, has three main sections that impart practical skills relevant to all specialties. Upon completion, physicians earn a certificate from UT Dallas and continuing medical education credits from the American Medical Association and TMA. 

TMF Helps With Value-Based Improvement, Outcomes

The TMF Quality Innovation Network Quality Improvement Organization's (QIN-QIO) Value-Based Improvement and Outcomes Network offers free consultations and tools to help you better understand and meet the goals of the Centers for Medicare & Medicaid Services Physician Quality Reporting System and value-based payment modifier programs. In addition, participants can attend live and on-demand webinars and conferences and visit online forums that allow peers and community leaders to share successful improvements and best practices.

This network is just one of three physician-focused programs TMF QIN-QIO established to help physicians save time, improve patient care, increase payments, and reduce costs associated with meeting certain Medicare requirements. The other two networks, focused on immunizations and behavioral health, help physicians benefit from — and not be penalized by — Medicare mandates.

TMF OIN-QIO will host a webinar from noon to 1 pm on Jan. 12 on how to use standing orders for adult immunizations to help your practice or facility be a leader in quality adult patient care. The speaker, L.J. Tan, MS, PhD, chief strategy officer for the Immunization Action Coalition, will show you how to implement standing orders in your practice or facility. Register on the Quality Net E-University website.  

For more information on participating in the Value-Based Improvement and Outcomes Network, visit the TMF QIN-QIO website, or download and complete the network participation agreement.

Participate in the Texas Two Step Mass CPR Event

Help the Texas College of Emergency Physicians, HealthCorps, TMA, and the American College of Emergency Physicians make history Feb. 6 by joining Texas medical students at the Texas Two Step CPR training. 

The goal of the event is to break the world record by teaching 20,000 people in one day to save a life with two simple steps: call 911, and initiate hands-only CPR. Visit the Texas College of Emergency Physicians website for more information. 

Training sites include high-traffic areas in Austin, College Station, Dallas, El Paso, Fort Worth, Galveston, Houston, Lubbock, and San Antonio. Local sponsors include Texas medical schools, county medical societies, legislators and city officials, and local emergency medical services agencies. 

PC Action Ad Nov 13

TMA's Newest Group Discount Program Vendor: EnviroMerica

Medical waste management services through EnviroMerica are now available to TMA members at a group member discount. EnviroMerica offers services that help simplify compliance and waste management for medical practices. With EnviroMerica, TMA physician members can access affordable, safe waste management pickup and disposal, with straightforward pricing and service contracts.

Members interested in learning more about EnviroMerica can visit the company's website or call (888) 323-0583. When requesting a quote, mention your TMA membership or use code TMA920 to quality for discounted services.  

EnviroMerica is just one of many services offered as perks of membership through TMA's group discount programs. The discounts— which cover car lease and rental, office supply, web marketing services, and more — allow you to leverage your membership in the largest state medical association in the country. Available only to TMA members, these programs are an excellent value that can help you save money on products and services you use every day in your practice or in your home. 

Last Call: TMA Anson Jones, MD, Awards

It's time again for TMA's Anson Jones, MD, Awards — a time to recognize outstanding health journalism. If you report health stories or columns to the public in your local media, enter the 2016 competition. Or if you've seen, heard, or read a great report by a local journalist, nominate it

The Physician Excellence in Reporting category is for physicians or medical students who author a health care column for a local newspaper or who host a regular health-focused radio or TV segment. Ten other award categories honor professional journalists in print, television, radio, and online media. Any health news published or broadcast in 2015 by a Texas general-interest media outlet is eligible.

Entries are due Jan. 10, 2016. Visit the Anson Jones webpage for more details. Questions? Email or call Tammy Wishard, TMA outreach coordinator, at (800) 880-1300, ext. 1470, or (512) 370-1470.

Free PDR App Puts Latest Drug Information at Your Fingertips

Stay up to date on the latest pharmaceutical drug information with the new official PDR drug information app, mobilePDR. It's free for physicians and medical students and is now available for Apple and Android devices.  

The app includes several thousand drug summaries written and continually updated by PDR's team of pharmacists. PDR designed and developed the app with active participation from physicians, medical students, pharmacists, and other health professionals. 

The app includes: 

  • A fast, easily accessible drug lookup function that simplifies the search for dosing, indications, adverse reactions, and other important drug information;
  • A side-by-side drug comparison tool;
  • A drug interaction checker; and 
  • A pill identification tool.  

This Month in Texas Medicine

The January issue of Texas Medicine features a cover story on Texas Medical Board chronic pain treatment rules and the obstacles Texas physicians are running into when attempting to adhere to them. In the issue, you'll also find information on potential relief from Medicaid's administrative roadblocks; conducting an office policies and procedures manual makeover; a TMA-hosted forum to help hospitals, medical schools, and others take advantage of $53 million in grant money to create new residency training slots; and a TMA proposed resolution to raise awareness of human trafficking.

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.  

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 Webinar

New Initiatives for Texas Medicaid Providers


Texas Health Steps programs — Free CME! 
Use coupon code THSEDU for free registration. 


Electronic Medical Records Implementation: Successful Strategies from the Front Lines  

Overcoming Barriers to Medical Home Implementation  

Conferences and Events

2016 TMA Winter Conference
Jan. 29-30
Hyatt Regency Austin

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Last Updated On

September 26, 2018