Not surprisingly, partisan political wrangling has delayed congressional action on funding that states need to prepare for and fight the Zika virus. And now it's mosquito season. Texas is home to 85 different species of mosquito, including the Aedes aegypti, the primary carrier of Zika. 

"It is only a matter of time before one of those mosquitoes bites an infected traveler and then passes the disease on to another Texan," TMA President Don Read, MD, wrote in a letter to the Texas congressional delegation. "Local and state public health officers in Texas are working hard to prepare for that day, but we need help. We have the experience and expertise necessary, but our public health infrastructure is not up to a task of this magnitude." 

Lab testing — especially of pregnant women — monitoring travelers, and keeping Texans informed about the state of the disease all need bolstering from federal dollars. "We already have waited too long," Dr. Read wrote. "We need that action now. Several months from now will be too late."

In Washington, D.C., Congress has been dragging its feet on funding to help the United States prepare for and battle the Zika virus. President Barack Obama requested $1.9 billion in emergency funds in February. In May, the House offered a plan that includes just under $700 million. The Senate's plan includes $1.1 billion.  

In May, Houston obstetrician Catherine Eppes, MD, whose high-risk pregnancy clinic has been overrun by women concerned about Zika infection, told the Senate Health and Human Services Committee Texas needs to find more ways to screen pregnant women for the Zika virus. "The combination of a relatively new but profoundly significant disease with little knowledge about the exact timing and rates of transmission, and complex, often inaccessible testing options leaves pregnant women and physicians frustrated," the member of the TMA Committee on Maternal and Perinatal Health said. "I think doctors would benefit from statewide dissemination of the options and costs for testing within our state and city health departments." 

Dr. Eppes also recommended Texas Medicaid and the Women's Health Program be authorized to support the screening and testing of their eligible populations.

The Texas Department of State Health Services (DSHS) reports that as of May 25, Texas had 36 confirmed cases of Zika virus disease. Of those, 35 were in travelers infected abroad and diagnosed after they returned home; one of those travelers was a pregnant woman. One case involved a Dallas County resident who had sexual contact with someone who acquired the Zika infection while traveling abroad. Nationally, as reported by the U.S. Centers for Disease Control and Prevention (CDC), 157 pregnant women in the continental United States and another 122 in U.S. territories, primarily Puerto Rico, had tested positive for the infection as of May.

DSHS is testing for Zika virus at its public health lab in Austin. CDC encourages Texas physicians to report suspected Zika virus cases to DSHS.

According to DSHS, Aedes aegypti mosquitoes can be found in Texas, particularly in urban areas in the south and southeast portions of the state. While there is no evidence of local transmission by Texas mosquitoes yet, state health officials have implemented Zika virus prevention plans in anticipation of increased mosquito activity and the potential for local mosquito transmission.

At a recent Texas Public Health Coalition "University of Health" educational session, former and current Texas health commissioners, the chair of TMA's Council on Science and Public Health, and a public health officer in the lower Rio Grande Valley gave legislative staffers an in-depth look into how Texas is preparing for the Zika virus. 

"We in public health would not be doing our job if we weren't planning for the eventuality that Zika would become locally transmitted," John Hellerstedt, MD, DSHS commissioner, told the crowd. "Large areas of Texas could be impacted." Coalition Vice Chair John Carlo, MD, stressed Texas should focus on the state's poorest communities, where decent housing and access to health care are lacking and where a Zika outbreak would have a devastating effect. Eduardo Olivarez, chief administrative officer for Hidalgo County Health and Human Services, spoke about the need for coordinating a patchwork of state and local agencies in the fight against a difficult foe. "You're not going to be able to spray this problem away," he said.

To help ensure Texas physicians have all they need to diagnose the virus, DSHS has updated its texaszika.org website with a supplemental testing information form and polymerase chain reaction (PCR) and serology specimen criteria form. The PCR test can confirm the presence of Zika virus. Serologic testing can detect Zika infection in people who may not have had symptoms, and the test can be conducted up to 12 weeks after infection. DSHS says a positive serologic test result requires confirmatory testing to pinpoint Zika because it can cross-react with other viruses, such as dengue.

DSHS is working with local officials in the Rio Grande Valley area, a potential hot spot for Zika virus transmission, to monitor mosquito activity. The agency reports spot trapping in the area in February yielded no Aedes aegypti mosquitoes. DSHS urges communities to consider expanding their surveillance in coordination with local mosquito control efforts.

The disease can cause fever, rash, muscle and joint aches, and red eyes, and also has been linked to the birth defect microcephaly and other poor birth outcomes in some women infected during their pregnancy. 

To help prevent the spread of Zika virus in Texas, DSHS also developed flyers and door hangers (available in English and Spanish) you can use in your office to educate your patients on protecting themselves from the disease. 

CDC issued Update: Interim Guidance for Prevention of Sexual Transmission of Zika Virus — United States, 2016. CDC's recommendations apply to men who have traveled to or reside in areas with active Zika virus transmission and their sex partners.

TMA and the Texas Association of Obstetricians and Gynecologists have prepared guidance for physicians on the Zika virus and pregnant patients.

State health officials continue to encourage people to follow travel precautions. CDC is advising pregnant women to delay travel to foreign countries where Zika is being transmitted. 

More Information 

General information about Zika virus

Information for clinicians

Protection against mosquitoes 

Zika virus travel notices

TMA and Texas physicians cheered when Congress repealed Medicare's Sustainable Growth Rate (SGR) formula last year. The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) not only removed the constant threat of Medicare payment cuts, but it also promised to simplify the ever-tightening thicket of federal regulations that strangle physicians' practices. 

TMA is less than enthusiastic, however, about the Centers for Medicare & Medicaid Services' (CMS') plans to implement the new law. TMA is studying the 426 pages of proposed MACRA regulations carefully and sent TMA chief lobbyist Darren Whitehurst and Angie Ybarra, TMA's director of clinical advocacy, to Washington for in-depth discussions with the American Medical Association and national specialty societies. A TMA staff team listened carefully to two MACRA briefing sessions that AMA set up with CMS officials. 

According to TMA Chief Executive Officer Louis J. Goodman, PhD, here are the association's topline observations so far: 

• MACRA is far more complex, confusing, and controlling than the Physician Quality Reporting System, meaningful use, and value-based modifier programs it is replacing.
• Compliance will be especially difficult for small practices that may end up with Medicare payment penalties, even if they spend the time and money to jump through all the new regulatory hoops.
• The system of bonuses and penalties pits physician practices against one another so that there will be winners and losers, regardless of how well all practices "perform" on these new quality standards. 

TMA needs physician feedback (email macra[at]texmed[dot]org) as it develops detailed official comments on the draft regulations. In the meantime, the association urges physicians from practices of all sizes to visit TMA's MACRA Resource Center to learn about the new law and proposed regulations.

In addition, read "Bracing for MACRA" in the July issue of Texas Medicine to learn about the new quality-based payment pathways Congress designed to replace the SGR and how TMA is helping practices navigate the labyrinthine Medicare payment paradigm. 

Thanks to lobbying from TMA and organized medicine, the Centers for Medicare & Medicaid Services extended the deadline for physicians and other health professionals, including advanced practice nurses and physician assistants, to reenroll in Medicaid to Sept. 25, 2016. The initial deadline for reenrollment, driven by a provision in the Affordable Care Act (ACA), was March 24. 

According to the Texas Health and Human Services Commission (HHSC), all physicians participating in Medicaid who have not met all ACA revalidation requirements must do so through reenrollment by Sept. 24, 2016. To avoid disenrollment and possible claims payment disruption, Texas Medicaid officials urge physicians to submit a reenrollment application before June 17, 2016.  

The reenrollment requirement applies to physicians and other health professionals who participate in Medicaid managed care, traditional fee-for-service Medicaid (each active Texas Provider Identifier suffix), the Texas Vendor Drug Program, and in long-term care services administered through the Texas Department of Aging and Disability Services. 

If an application has deficiencies but is submitted by June 17, HHSC says there will not be gaps in payment after Sept. 24, if the physician makes a good faith effort to resolve application errors. Applications submitted after June 17 will be processed, but HHSC cannot guarantee those applications will be completed by Sept. 24, which could result in physician disenrollment from Texas Medicaid and denial of payment.

TMA and Texas Medicaid officials encourage Texas physicians to get ahead of the complex reenrollment process.

More Information

Acute Care Physicians Reenrolling Through Texas Medicaid and Healthcare Partnership

• TMHP Provider Re-enrollment webpage
• TMHP Provider Re-enrollment Application
• TMHP Provider Enrollment Tool Quick Reference Guide
• Instructions on verifying your reenrollment compliance status, as well as the date by which you must next reenroll  
• Contact a TMHP provider enrollment representative for assistance at (800) 925-9126, option 2.
• Email Provider.Enrollment.Mailbox[at]tmhp[dot]com.

Ordering- and Referring-Only Physicians

Ordering- and referring-only physicians are those whose only relationship with Texas Medicaid involves ordering or referring services for Medicaid clients. They also must enroll with Texas Medicaid as participating physicians. 

• Information for Ordering- and Referring-Only providers
• Enroll online.
• Paper application

It's no secret the Texas Medical Association has been less than thrilled with the meaningful use electronic health record (EHR) incentive program. For starters, the Centers for Medicare & Medicaid Services (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 to attest remained in the calendar year. That left them at risk for a penalty. CMS vowed to grant hardship exemptions for 2015 for those eligible physicians who were unable to attest due to the lateness of the rule.

In December, Congress adopted S 2425, known as the Patient Access and Medicare Protection Act, which allows one exception form for individual physicians and groups so they can list all physicians and other health professionals who are claiming the same exemption category.

If the 2015 meaningful use modification rule delay prevented you from meeting the criteria for the 2015 reporting year, listen up. You need to review the hardship application categories to see if any of them apply to you. Categories include:

• Insufficient Internet connectivity, 
• Extreme and uncontrollable circumstances, 
• Lack of control over the availability of certified EHR technology, and
• Lack of face-to-face patient interaction.  

An exemption will have an impact on your 2017 payments only. You must reapply for exemptions each year. 

You have until July 1 to submit the hardship application. CMS provided some additional information on the hardship exception instructions.  

The American Medical Association encourages all physicians participating in the 2015 Medicare meaningful use program to apply for the hardship. Applying for the hardship will not prevent a physician from earning an incentive. It simply protects a physician from receiving a meaningful use penalty. Therefore, physicians who believe that they met the program requirements for the 2015 reporting period should still apply for the hardship protection. 

If you have questions about the hardship exceptions, contact TMA's Health Information Technology Department by calling (800) 880-5720 or by email.

Updated: March 1, 2016

It's that time in the state's two-year budget cycle when state agencies prepare funding requests for the Texas Legislature to consider in next year's session. No agency's budget is more important to physicians than that of the Texas Health and Human Services Commission (HHSC), whose massive portfolio includes the state's Medicaid, public health, mental health, and women's health programs. 

In an official letter to HHSC leadership, TMA and state specialty societies representing family physicians, pediatricians, and obstetrician-gynecologists laid out physicians' funding priorities for the 2018–19 state budget. Competitive physician payments in Medicaid and reversal of the steep funding cuts for dual-eligible patients topped TMA's list of recommendations. 

TMA also called for better funding for women's preventive, primary, and behavioral health care; mental health and substance abuse services; local and state infectious disease surveillance; vaccination and antitobacco programs; and early childhood programs for children with developmental or physical disabilities.

The Texas Department of State Health Services (DSHS) recommends testing patients for the parasite Cyclospora if they have diarrheal illness lasting more than a few days or diarrhea accompanied by severe anorexia or fatigue. Diagnosis of cyclosporiasis requires submission of stool specimens for "Ova and Parasite" testing with additional specific orders for Cyclospora identification. DSHS says a single negative stool specimen does not exclude the diagnosis; three specimens are optimal. 

Texas has experienced a large number of cyclosporiasis cases during the past four summers. DSHS reports at least some of the Texas cases in 2012–15 were associated with consumption of fresh cilantro imported from Mexico. Rapid reporting to public health authorities, enabling prompt investigation to identify possible common exposures, is essential to preventing additional cases of cyclosporiasis this year. 

Symptoms of cyclosporiasis usually begin two days to 14 days after ingestion of Cyclospora oocysts in contaminated food or water. Profuse diarrhea can last weeks to months and may relapse. Additional symptoms may include anorexia, fatigue, weight loss, abdominal cramps, bloating, increased gas, nausea, vomiting, and low-grade fever. Learn more about Cyclospora from the Centers for Disease Control and Prevention.

Various types of imported fresh produce besides cilantro have been linked to U.S. outbreaks of cyclosporiasis, including raspberries, basil, snow peas, mesclun lettuce, and bagged salad mix. As always, thorough washing of fresh produce is recommended but may not eliminate the risk for transmission as Cyclospora can be difficult to wash off produce. DSHS says direct person-to-person transmission of the parasite is highly unlikely to occur. 

Physicians and laboratories should promptly report confirmed cyclosporiasis cases to their respective local health department or DSHS. Contact DSHS at (800) 705-8868.  

Your TMA membership delivers expertise on the business of medical practice. Physician members turn to TMA for help with challenges like contract negotiation and structuring salaries, and for access to dynamic programs like the TMA Leadership College. 

If you're just starting out, a TMA practice setup can put you on solid footing from day one without costing you a fortune in time and money. 

As a TMA member, you also have access to resources like these for running your practice "like a boss":  

• Business of Medicine Resource Center: Regardless of what stage of practice you're in, TMA has tools to help you organize your finances, build a patient base, and make business decisions with confidence. 
• Practice operations consulting: TMA’s experts can work with you to keep your practice at peak performance. Services range from an operations or revenue cycle assessment to an embezzlement risk review. Custom services are also available
• Tools for surviving residency and beyond: Get convenient, on-demand access to the information you need to survive residency and to transition successfully into active practice (members only).
• Insurance: You can protect yourself personally and professionally using exclusive products and services from TMA endorsed vendors TMA Insurance Trust and Texas Medical Liability Trust. 

Visit the TMA website for more information on all the ways TMA can help you with the business of practicing medicine.

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 by June 10.

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.

Bacterial pneumonia is the second-leading cause of potentially preventable hospitalizations in Texas. TMA's Be Wise — Immunize^SM Local Impact Grants can help counties with high rates of the disease to improve this statistic — or meet other vaccination needs — with local vaccination events. 

TMA offers grants of up to $2,500 through Be Wise — Immunize to TMA member-physician practices/clinics, county medical societies (CMSs), TMA Alliance chapters, and medical student chapters. The funds can support shot clinics to vaccinate children, adolescents, and/or adults; any recommended vaccination — including bacterial pneumonia — is eligible. Be Wise — Immunize is accepting applications until July 1. 

Only congestive heart failure lands more people in the hospital than bacterial pneumonia, according to the Texas Department of State Health Services' (DSHS') list of the top 10 causes of preventable hospitalizations. Combined, these two illnesses account for nearly half of admissions (43.9 percent) and costs (48.2 percent, or $20 billion) for potentially preventable hospitalizations. DSHS has identified counties with high rates of bacterial pneumonia. Many are clustered in East Texas and South Texas.

Local Impact Grant applicants should submit a proposal at least four months before a project is scheduled to begin, and grantees have up to 12 months to use the funds. Now is the time to apply if you want to provide flu or other vaccinations, such as bacterial pneumonia, this fall. TMA will accept applications again on Nov. 1 for shot clinics in early 2017. 

To plan your free or low-cost vaccination event, check out the Be Wise — Immunize Quick Start Manual: A Step-by-Step Vaccination Outreach Guide. For more information, contact Tammy Wishard, TMA's outreach coordinator, at (512) 370-1470 or (800) 880-1300, ext. 1470.

TMA actively works to improve vaccination rates in Texas through Be Wise — Immunize. More than 300,000 shots have been given to Texas children, adolescents, and adults since the program began in 2004. 

Be Wise – Immunize is a joint initiative led by TMA physicians, medical students and the TMA Alliance. It is funded by the TMA Foundation in 2016 thanks to major gifts from H-E-B and TMF Health Quality Institute, along with generous contributions from physicians and their families. 

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

TMA is proud to announce a newly approved travel program for members through Gohagan & Company, a leading provider of international and domestic travel experiences. TMA members, friends, and family are invited to take the inaugural tour Feb. 12–21, 2017, to explore the Wonders of the Galapagos Islands. Bohn Allen, MD, and his wife, Ann, will serve as hosts throughout the trip. 

View the Galapagos Islands brochure for more information, or call (800) 922-3088 to book today. Then save the date for these additional tours in 2017: 

• Italian Lakes and Venice: May 11–19, 2017
• The Great Journey Through Europe: June 15–25, 2017
• Symphony on the Blue Danube: June 22–July 1, 2017
• The Riviera and Islands of France, Italy, and Spain: October 2–10, 2017 

And don't forget: TMA members can always access a worldwide inventory of hotels and car rentals with exclusive discounts. Whether travelling for work or pleasure, you can take advantage of savings that average 10- to 20-percent below the best available rates. As a special summer vacation giveaway, if you book a hotel or car between now and Sept. 30, you will be entered to win a free booking.

Find more information on these programs by visiting the TMA Group Discount Programs page. 

Today is the last day to register for 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. 

The June issue of Texas Medicine features a cover story on New Mexico's House Bill 270, which gives Texas doctors a new tool to keep their Texas tort reform protections when treating patients from New Mexico. In the issue, you’ll also find information on Medicare paying physicians for conducting end-of-life care planning with patients; U.S. Department of Veterans Affairs roadblocks that leave veterans on long waiting lists to get care; organized medicine's efforts to curb or eliminate coal-fired power plant emissions; the results of a study on resident duty hours; and the growing popularity of concierge medicine.

Click to launch the digital edition in a new window.

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