Action: April 15, 2016

TMA Action April 15, 2016   News and Insights from Texas Medical Association

Protect Your Practice From Cyber Attacks
TAPA Creates Sample Release Forms for New Mexico Patients
DocbookMD: New Owners, Same Great Member Benefit
State Pharmacy Board Proposes Changes to Compounding Rules
Supreme Court Backs TMA in Tobacco Tax Case
Open Payments Review and Dispute Period Ends May 15
Changes to New State Notifiable Conditions List
Physicians Foundation Survey Gauges Your Satisfaction
DSHS: Expect Delay in Newborn Screening CF Tests
Be a Preceptor and Shape the Next Generation of Medicine
TMF Launches Physician Practice Quality Improvement Award
2,350 Texas Kids to Get Bike Helmets From TMA This Month
Preview the Excitement of the TMA Foundation Gala
Register for the Texas Primary Care and Health Home Summit
This Month in Texas Medicine

Protect Your Practice From Cyber Attacks

Last month, TMA learned a South Texas member physician was the victim of a cyber attack in which a thief hacked into the physician's computer and demanded money in exchange for the key to access the encrypted information. Since then, TMA has been working to publicize steps you should take to safeguard your system from cyber attacks.

"TMA would like to again warn our members of cyber hackers and the possibility of ransom requests for the return of your patients' billing information and medical records," said TMA President Tom Garcia, MD. "Please consider reviewing your liability coverage to include this risk because it is a risk." 

The Texas Medical Liability Trust (TMLT) includes comprehensive cyber liability coverage in all of its policies. TMLT also offers customized services to help large groups, small offices, and individual physicians arm themselves against online threats. Learn more about TMLT's cyber liability coverage

TMLT compiled this list of 10 common causes of compromised patient data: 

  1. Cyber criminals: Cyber attacks account for 45 percent of data breaches in health care organizations, according to the Ponemon Institute's 2015 Fifth Annual Benchmark Study on Privacy and Security of Healthcare Data.
  2. Lost or stolen portable devices: TMLT recommends using whole disk encryption on your mobile devices whenever possible and installing a remote wipe utility to erase all information from the lost or stolen device.
  3. Failure to use encryption: TMLT recommends encrypting all email, cloud storage, and Wi-Fi networks.
  4. Work culture and habits: TMLT urges practices to create a work culture that constantly promotes patient data security and privacy, as well as ongoing training in privacy and security for physicians and office staff. TMA Practice Consulting offers HIPAA training for your practice. For information, call (800) 523-8776. 
  5. Data security that lags behind current technology: TMLT cautions practices not to rely solely upon antivirus/malware software but to take a multilayered approach and to work with information technology professionals who are familiar with the latest technology.
  6. No cyber security plan: TMA's on-demand webinar HIPAA Training for Medical Office Staff provides training on state and federal HIPAA compliance for medical offices. TMA's Policies & Procedures: A Guide for Medical Practices includes a comprehensive, customizable HIPAA and HITECH privacy and security section.
  7. Careless use of passwords: TMLT says medical office staff and physicians should avoid sharing passwords. TMLT suggests using multifactor authentication and avoiding password-reset questions that cyber criminals could answer easily by researching you or your family.
  8. Unsecure Wi-Fi networks: TMLT says practices that must use a public Wi-Fi network should install a virtual private network encryption tool and protect Wi-Fi with a secure password. In addition, use a secure network that is configured with a firewall and encrypts all data.
  9. Legacy systems: Relying on outdated computer systems, or legacy systems, to store data makes you an easy target for hackers. TMLT suggests routinely performing security risk assessments that include your legacy system to uncover possible data breach risks. 
  10. Cloud storage: Ensure any cloud storage provider you are considering offers secure storage and meets HIPAA compliance requirements. Know their security protocols and if they are willing to sign a business associate agreement. Avoid storing protected health information, personally identifiable information, and financial data on cloud-based services that are not covered by a business associate agreement.

For additional guidance, check out TMLT's slideshare on cyber security best practices. 


TMA says physicians should protect themselves against ransomware and other malware by making sure their computer systems are backed up regularly to an external drive or backup service. In addition, physicians should consider setting up their email accounts to deny emails sent with executable files (.exe file extensions), patch or update their software regularly, and enable automatic software updates whenever possible. Computer systems should have a reputable antimalware software, as well as a software firewall to help detect threats. Taking these precautions should allow you to avoid infection or quickly recover from a malware attack.

Unfortunately, health care entities are a popular target for cyber criminals. Eighty-one percent of health care executives say their organizations have been compromised by at least one malware, botnet, or other cyber attack during the past two years, and only half feel they are adequately prepared to prevent attacks, according to the 2015 KPMG Health Care and Cyber Security Survey. More concerning, 16 percent of health care organizations said they cannot detect in real time if their systems are compromised.

Malware is the most frequently reported line of attack, cited by 65 percent of KPMG survey respondents. Botnet attacks, in which computers are hijacked to issue spam or attack other systems, and "internal" attack vectors, such as employees compromising security, were cited by 26 percent.

Areas with the greatest vulnerabilities within an organization include external attackers (65 percent), sharing data with third parties (48 percent), employee breaches (35 percent), wireless computing (35 percent), and inadequate firewalls (27 percent). 

If you are the victim of a cyber crime, report it to the FBI. 

For more information, read "Cyber Crimes" in the July 2014 issue of Texas Medicine

TAPA Creates Sample Release Forms for New Mexico Patients

The New Mexico Legislature recently passed House Bill 270, which allows Texas physicians to obtain a signed agreement from New Mexico patients stating that should they wish to file a lawsuit they will do so in Texas court. To assist physicians in taking advantage of the law's protections, the Texas Alliance for Patient Access (TAPA) has developed two forms, one for emergency treatment and one for voluntary treatment.

In consultation with an attorney, TMA suggests physicians who treat New Mexico patients or patients living in other states consider adopting this language in the practice forms patients sign. 

View the emergency treatment and voluntary treatment forms.

DocbookMD: New Owners, Same Great Member Benefit

On March 1, 2016, Scrypt, Inc., developers of secure and compliant productivity tools for regulated industries, announced that it had completed the acquisition of DocbookMD, adding the HIPAA-secure messaging platform to its suite of document management products. 

TMA staff have met with the Scrypt team as well as DocbookMD creators Tim Gueramy, MD, and Tracey Haas, DO. All of them have voiced their commitment not only to continuing to offer all TMA members this free and powerful member benefit, but also to dedicating additional development personnel to the platform to further improve the app and its capabilities.

Designed by physicians and for physicians, DocbookMD is an exclusive HIPAA-secure application for both Apple and Android smartphones and tablets that allows physicians to send HIPAA-compliant messages bundled with photos of x-rays, EKGs, wounds, and more, just as if they were sending a text. 

Quick things to know about the acquisition:

  • The DocbookMD product platform and functionality will remain the same.
  • The founders, Drs. Gueramy and Haas, are still involved in DocbookMD and will bring their insight and experience to the other HIPAA-secure products Scrypt offers. Dr. Gueramy is now the Scrypt medical director and a member of its board of directors.
  • Scrypt has appointed a dedicated product manager to DocbookMD, who will focus on the quality and stability of the app and on planning new features.
  • The development and support teams will remain the same, but additional members will be added to further improve the product and to provide excellent customer support.

Founded in 1998, Austin-based Scrypt now has a staff of more than 60 people providing solutions in document management and productivity. The company operates specifically in heavily regulated industries.

From the Scrypt website: "We remain dedicated to eliminating manual process and paper so that our customers can work better, with confidence."

State Pharmacy Board Proposes Changes to Compounding Rules

The Texas State Board of Pharmacy (TSBP) has proposed changes to its rules for sterile compounding in part to stay consistent with proposed new United States Pharmacopeia (USP) standards, which have caused controversy in the allergist-immunologist community.

TSBP says it's proposing the changes in part to "update the requirements for sterility testing and humidity to be consistent with USP 797." Recent proposed changes to that chapter of USP's standards covering allergen extract compounding have drawn the ire of TMA and many allergists, who said the changes would make sterile compounding of allergen extracts in a physician's office nearly impossible. USP is now reviewing comments on the proposed changes. 

"Texas allergists have indicated that if the USP [U.S. Pharmacopeial Convention] proposed revisions were adopted, they would be unable to prepare allergen immunotherapy, and many patients would lose access to individual patient therapy," states TMA's comment letter to USP regarding its proposed rule revisions. TMA's primary concern deals with USP's proposal to delete the current exception for allergen extracts.

For more on the proposed USP standards, see the May 2016 issue of Texas Medicine.

The TSBP proposal would require clean rooms for low- and medium-risk sterile compounding preparations to be maintained at a temperature of at least 20 degrees Celsius or cooler, with a humidity below 60 percent. The proposal also clarifies requirements for blood-labeling and recordkeeping. 

View the rule proposal; TSBP's proposed changes begin on page 1,799.

 Action TMLT Ad 10.15       

Supreme Court Backs TMA in Tobacco Tax Case

The Texas Supreme Court unanimously rejected a challenge to a tax lawmakers enacted in 2013 to recover health care costs from the tobacco companies that were not part of the $10 billion-a-year 1998 lawsuit settlement between the state and the nation's five largest tobacco manufacturers. The settlement funds and the tax both were intended to recover the health care costs associated with smoking. TMA had urged the high court to take the case. 

"Whether produced and sold by Small Tobacco or by Big Tobacco, tobacco products cause the same health problems and inflict the same physical and financial burdens upon Texas citizens and the State budget," TMA wrote in its amicus brief to the court. "Both should, therefore, have to pay their fair share of tobacco-related health costs whether that be through a judgment, settlement, tax or otherwise."

The case now goes back to the Third Court of Appeals, which will consider other arguments from Small Tobacco it hasn't ruled on yet.

Open Payments Review and Dispute Period Ends May 15

The Centers for Medicare & Medicaid Services (CMS) announced the beginning of the 45-day Open Payments review and dispute period. After the conclusion of the review and dispute period on May 15, 2016, CMS will publish the 2015 payment data and updates to 2013 and 2014 data on June 30, 2016. 

CMS made public physician payments reported by manufacturers of drugs, medical devices, and biologicals that participate in federal health care programs. 

If you're planning to review your 2015 Open Payments data, first test your CMS Enterprise Identity Management (EIDM) Portal log-in credentials. If you have a locked account or other log-in problems, visit the Frequently Asked Questions for EIDM Users webpage. 

Visit the AMA website for step-by-step registration instructions and to review and dispute your data. For answers to additional questions, email Medicare's Open Payment Help Desk or call (855) 326-8366.

Changes to New State Notifiable Conditions List

The Texas Department of State Health Services (DSHS) has released the 2016 Texas Notifiable Conditions list, which features some changes, including expanded descriptions of tuberculosis (TB) and TB infection to clarify reporting expectations.

Other notable changes featured in this year's list include: 

  • Adding six human helminth infections in response to Texas legislation mandating surveillance for emerging and neglected tropical diseases in Texas: ascariasis, echinococcosis, fascioliasis, hookworm (ancylostomiasis), paragonimiasis, and trichuriasis. DSHS says reported cases will be investigated to determine possible local transmission and disease burden. 
  • Expanding arboviral infections to encompass all arboviruses, including emerging arboviruses such as chikungunya and Zika.
  • Expanding invasive Haemophilus influenzae infection from type b to all invasive Haemophilus influenzae regardless of type. DSHS adds that isolates for all invasive H. influenzae from children younger than 5 years must be submitted to a public health lab for testing. 
  • Expanding Creutzfeldt-Jakob disease to include all human prion disease. 
  • Changing reporting time frames for HIV from one week to one business day by phone for acute cases and for multidrug-resistant organisms, and for carbapenem-resistant Enterobacteriacea and multidrug-resistant Acinetobacter from immediately to one day. 
  • Deletion of relapsing fever along with its reporting requirement. DSHS says the condition is not nationally notifiable, and Texas has not had a reported case in at least 12 years.

Physicians Foundation Survey Gauges Your Satisfaction


How satisfied are you with the current state of medicine? The Physicians Foundation is surveying you and your 650,000 physician colleagues across the country to determine just that. The survey asks for your thoughts on health reform, electronic health records, new physician payment methods, ICD-10, and a variety of other topics. Take a few minutes to complete the survey

A full copy of the final survey report will be emailed to all physicians who participate, and participants will also be entered to win one of five $500 Amazon gift cards and one $5,000 Amazon gift card. Additionally, the Physicians Foundation is offering a $5,000 grant to the state medical society that achieves the most total survey responses and a $5,000 grant to the state medical society that achieves the highest per capita response. As a founding member of the Physicians Foundation, TMA expects to be in the running to win both of those grants. 

"This is the one national survey that allows physicians to share their perspective on the state of the medical profession," said Walker Ray, MD, Physicians Foundation president. "We'd like to hear from as many physicians as possible so we can accurately understand — and share with the public — physicians' perspectives on the most significant issues in medicine and health care today."

A nonprofit, grant-making organization, the Physicians Foundation is determined to strengthen the patient-physician relationship and help physicians sustain their medical practices in today's practice environment. The Physicians Foundation focuses on physician leadership, physician practice trends, physician shortage issues, and the impact of health care reform on physicians and patients.

To access previous Physicians Foundation surveys, visit the foundation's website.

 TMAIT Action Ad 6.15     

DSHS: Expect Delay in Newborn Screening CF Tests

As of April 1, the Texas Department of State Health Services (DSHS) laboratory has temporarily ceased reporting abnormal results of the Cystic Fibrosis (CF) Mutation Panel based on in-house testing. DSHS informed TMA and those who conduct newborn screening that the Texas newborn screening laboratory received notification that some reagents used to identify mutations as part of the CF newborn screen have been recalled by the manufacturer due to potential false-positive results. 

DSHS says specimens can be forwarded to a reference laboratory for CF DNA testing until the department's laboratory can reestablish the full testing. There will be no additional cost to submitters. 

All previously reported CF DNA results are considered accurate and not affected by this recall, according to DSHS. Rachel Lee, PhD, DSHS Biochemistry & Genetics Branch manager, says the department hopes to resume full testing in late May or early June.

DSHS has provided answers to these frequently asked questions:

What specimens may be affected? 

Only second-screen specimens with an elevated immunoreactive trypsinogen (IRT) or first-screen specimens with an elevated IRT for which the laboratory has not received the second screen within 30 days after birth

How does this affect newborn screening test results?   

  • There may be a delay in reporting the second-tier CF Mutation Panel results. No delay in reporting of other newborn screening results is expected. 
  • If a specimen is forwarded for CF Mutation Panel testing, a statement of "final report with Cystic Fibrosis Transmembrane Conductance Regulator (CFTR) Mutation Panel results to follow" will be included in the Screening Result Note.
  • When CF Mutation Panel results are available, a revised report that includes the updated results will be sent to the submitting facility and available through the Newborn Screening Web Application.
  • If the CF DNA results are abnormal, the physician will receive a call from the clinical care coordination nurse to report the results. 

What action should the health care submitters take?   

  • Monitor and ensure receipt of a final report with CFTR Mutation Panel results. Final results including the CF Mutation Panel may take up to 10 additional days.
  • Carefully read all screening result notes, and follow recommendations accordingly.
  • Continue to take appropriate actions to follow up on all abnormal newborn screening results.
  • Contact DSHS newborn screening laboratory for any concerns or questions on CF DNA results. 

If you have any questions, contact Dr. Lee.

Be a Preceptor and Shape the Next Generation of Medicine

The Texas Chapter of the American College of Physicians (TXACP) is seeking physician mentors for the summer 2016 General Internal Medicine Statewide Preceptorship Program (GIMSPP). 

Preceptors open the doors to their practice to provide a medical student with personal instruction, training, and supervision for three to four weeks. Students get the opportunity to observe the daily routine of the physician, experiencing the variety that the practice of internal medicine provides. For physicians, benefits of preceptorship include:  

  • The opportunity to give back while rekindling your passion for medicine, 
  • The ability to help advance primary care in Texas, and
  • An enriching experience for you and the student.  

This year, preceptors will also be eligible for one of the following incentives:  

Preceptors must be board certified in internal medicine, possess a current Texas medical license with no restrictions from the Texas Medical Board, and practice at least 40 percent to 50 percent general internal medicine apart from any other subspecialties.

For more information on the program or to fill out the preceptor application, visit the GIMSPP website

TMF Launches Physician Practice Quality Improvement Award

Physician practices continue to make great strides in providing reliable preventive services by using health information technology and effective care management methods. We think these practices should be recognized for their hard work. TMA, the Texas Osteopathic Medical Association (TOMA), and TMF Health Quality Institute have partnered again to offer the Physician Practice Quality Improvement Award program. 

The application process is simple. Download the program overview and criteria to learn what your practice needs to do to prepare to complete an online application by June 10, 2017. Award-winning practices will receive commemorative items to display and will be recognized through a media campaign. Announcements will also be made at TMA and TOMA meetings. Learn more, and view the list of previous award recipients.

2,350 Texas Kids to Get Bike Helmets From TMA This Month

April is Child Safety Month, and TMA's Hard Hats for Little Heads program is out to make the world safer for thousands of Texas children. TMA physicians and other volunteers are giving away 2,350 free bicycle helmets to Texas kids at 18 community events across the state in April. They also are teaching parents and children the importance of properly fitting the helmet for maximum protection. 

TMA created the Hard Hats program in 1994 to help prevent head injuries by encouraging helmet use for all types of sports on wheels: bicycling, skateboarding, rollerblading, and riding a scooter. TMA has given nearly 240,000 helmets to Texas children since the program began. It is supported by a grant from the TMA Foundation, TMA's philanthropic arm, thanks to funding from Blue Cross and Blue Shield of Texas through its Healthy Kids, Healthy Families initiative, and other donors.

Preview the Excitement of the TMA Foundation Gala

You could win a Caribbean cruise, luxurious vacation packages to Paris or Santa Fe, a signed Michael Jordan jersey, one-of-a-kind jewelry, children's items, and much more at the TMA Foundation's gala, As Time Goes By: An Evening in Casablanca, held during TexMed 2016 on Friday, April 29. 

Guests at the gala will be able to bid on auction items using their mobile device or at one of the bidding stations in the reception area.

Buy your tickets and learn more about the items up for bid on the foundation webpage.

Register for the Texas Primary Care and Health Home Summit

Be part of the fourth annual Texas Primary Care and Health Home Summit June 9–10 at the JW Marriott in Houston. The event, presented by the Texas Medical Home Initiative and Texas Health Institute and cosponsored by TMA, provides a learning laboratory for primary care transformation in Texas. 

Sessions include fundamentals of the adult and pediatric health home, using telemedicine in your office to better manage chronic conditions, integrating behavioral health into the primary care office, improving chronic pain management, leveraging technology for better patient engagement, and elements of a successful accountable care organization. 

This year's summit will feature three keynote addresses, three in-depth presummit courses, 23 breakout sessions, and breakfasts with faculty members. You may register online

This Month in Texas Medicine

The April issue of Texas Medicine features a cover story on new funding and a streamlined state approach to women's health that could improve access to screenings and family planning services for low-income women and girls. In the issue, you'll also find information on The University of Texas at Austin Dell Medical School's course that teaches residents some of the business and job-hunting basics they'll need; mining electronic health record data to improve patient care; the two prestigious speakers TMA has secured to headline the TexMed 2016 General Session; Teladoc's lawsuit against the Texas Medical Board; and the first set of new, national standardized quality measures.

Click to launch the digital 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.   

Apply for Meaningful Use Hardship Exception

Medicaid Reenrollment Deadline

TMA Education Center

The TMA Education Center offers convenient, one-stop access to the continuing medical education Texas physicians need. TMA's practice management, cancer, and physician health courses are now easier than ever to find online.  

On-Demand Webinars

Dealing With Difficult Patients
HIPAA Training for Medical Office Staff
New NPP Regulations: Rules You Need to Know

Conferences and Events

TexMed 2016
April 29-30
Dallas Hilton Anatole

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Last Updated On

December 07, 2016