Action: Sept. 1, 2017

 TMA Action Sept. 1, 2017 

  News and Insights from Texas Medical Association

TMA Backs Physician in Breach-of-Contract Lawsuit
Health and Human Services Commission Announces Further Changes
Texas Physicians to Play Integral Role in Harvey Recovery
The “Hidden Crisis” of Coverage Denials
Expanded HIV Testing Recommended as Clusters Grow
More Rio Grande Counties Added to Zika Testing List

Champions Are Made; HPV Vaccine Champions Are Nominated
Set Your Office Up With Supplies Using TMA Group Vendor Office Depot
20-Percent Discount on LED Bulbs and Fixtures for TMA Members
You've Mastered the Art of Medicine. Next Up? Help With Business
This Month in Texas Medicine

TMA Backs Physician in Breach-of-Contract Lawsuit

TMA is supporting a physician who wants the Texas Supreme Court to take another look at a breach-of-contract lawsuit in which he claims he was fired without due process.

TMA intervened in support of physicians' right to make clinical decisions "in the best interest of the patient" without "fear of termination."

TMA filed a friend-of-the-court brief in Community Health Systems Professional Services Corporation, et al. v. Hansen, telling the Supreme Court it's important that nonprofit health corporations provide due process when a physician "faces termination based on the physician's medical performance or professional conduct."

According to court filings, Henry A. Hansen II, MD, was terminated three years into a five-year contract with Regional Employee Assistance Program (REAP), a nonprofit health corporation in College Station that employs physicians who practice at for-profit hospitals.

Dr. Hansen’s contract, which ran through April 2012, could be terminated for cause during the first three years or without cause beginning in the fourth year if annual practice losses for years three, four, or five exceeded a certain amount. If the contract was terminated without cause for practice losses, he wasn't entitled to due process rights — but if he was fired for cause, he was entitled to due process.

Dr. Hansen claims that the decision to terminate him was in the works long before the REAP board did so, at the request of hospital Chief Executive Officer Thomas W. Jackson, in February 2010. Mr. Jackson asked the board to do so because of "clinic losses" in 2008 and 2009 and because of "several behavioral problems" he said Dr. Hansen was exhibiting, Dr. Hansen's court filings claim. The REAP board's termination was purportedly without cause.

But Dr. Hansen's filings claim the board wasn't given any information on practice losses for the contract's third year to make its decision, so it was "impossible" for the board to terminate him without cause. The filings say Dr. Hansen didn't learn of the termination until the end of the third year of his contract, more than two months after the board made the decision. He filed suit the following October. 

The Supreme Court in June held that REAP had conclusively established that it "complied with the contractual conditions to a 'without cause' termination."

TMA's brief supporting Dr. Hansen's motion for rehearing says the "use of the term 'behavioral problems,' like the use of the term 'disruptive behavior,' often fails to tell the full, or even an accurate, story." TMA says in order to determine whether such conduct "is merely patient advocacy … or is actually patient endangerment," a physician must receive due process.

"Otherwise, physicians may be inhibited from exercising their independent medical judgments and doing what they believe to be in the best interest of the patient due to fear of termination," TMA wrote. "This strikes at the very heart of the prohibition against the lay control of medical practice."

Dr. Hansen requested a rehearing in late July. TMA filed its brief on Aug. 14.

Health and Human Services Commission Announces Further Changes

More changes are afoot at the Texas Health and Human Services Commission.

The state agency that oversees state health and human services activities announced last month that it will consolidate several programs while adding four members to its leadership team. TMA staff is assessing how the changes might affect the provision of quality Medicaid, mental health, and public health services in the state.

The changes are the second phase of a planned transformation, Executive Commissioner Charles Smith said in a statement.

Starting Sept. 1, most Department of Aging and Disability Services programs will move to the commission's new Regulatory or Facilities divisions, Mr. Smith said. Also, many of the regulatory functions of the Texas Department of State Health Services and the Texas Department of Family and Protective Services will be transferred to the commission. 

Mr. Smith said additions to the leadership team include:

  • Enrique Marquez, who will be the new deputy executive commissioner for Medical and Social Services. His new division will include Medicaid and CHIP Services, Access and Eligibility Services, Intellectual and Developmental Disabilities and Behavioral Health Services, and Health, Developmental, and Independence Services. 
  • David Kostroun, who will take over the newly created role of deputy executive commissioner for the Regulatory Services Division. He will oversee programs such as health care facilities, long-term care facilities, and child care licensing.  
  • Mike Maples, who will be the commission’s first deputy executive commissioner for the State Facilities Division. He will oversee 10 state hospitals and clinics and 13 state-supported living centers. 

The commission is also creating a chief policy officer, who will oversee innovation, performance management, policy development, and data analysis, Mr. Smith said. 

Texas Physicians to Play Integral Role in Harvey Recovery

Although the rains have stopped, the public health concerns associated with Hurricane Harvey will continue. The knowledge and expertise of Texas physicians will be called upon as hundreds of thousands of people begin to move back into affected areas and rebuild their lives.

Help Reopen Practices Damaged by Harvey

The Texas Medical Association and the TMA Foundation are asking physicians statewide to help their colleagues rebuild or repair practices damaged by Hurricane Harvey.

Make a tax-deductible donation today to support TMA's Disaster Relief Program, administered by the Physicians Benevolent Fund, which provides grants to affected physicians. 

"You will receive many solicitations in the coming days to help meet the needs of the thousands of Texans forced out of their homes, and I hope you find it in your heart to support those worthy causes," TMA President Carlos J. Cardenas, MD, said in a letter to TMA members. "But as physicians and friends of medicine, I also hope you will help the Texas Medical Association and the TMA Foundation reestablish patient care in the disaster zone. We don't know yet how many physician practices were damaged or demolished by Harvey, but the widespread damage all the way from Corpus Christi through East Texas tells us that number will be high. Too high. Much too high." 

 Donate Now Button  

Established originally after Hurricane Rita, the TMA Disaster Relief Program helps cover expenses (not covered by insurance or other funding) related to relocating or rehabilitating a physician's medical office. This may include replacing equipment, aiding needed staff, rebuilding patient records, and other similar costs — all towards the goal of helping physicians once again begin treating their patients.

After Rita and then Ike, TMA's Disaster Relief Program helped physicians meet uncovered expenses such as vaccines, telephone system replacements, signage, and medical laboratory supplies. Thanks to your help, they overcame those obstacles more quickly and got back to taking care of patients sooner.

Thank you for donating to the TMA Foundation, the philanthropic arm of TMA, and supporting "Physicians Caring for Texans." 

Note: Contributions are deductible for federal income tax purposes in accordance with applicable law.

Rain Not in Friday Forecast, But Flooding to Continue

The forecast remains dry Friday for areas that have seen catastrophic flooding, according to a situation report from the Texas Department of Public Safety

Although rains have stopped, flooding is expected to continue in areas near the coast as waters move downstream.

According to the Department of State Health Services, the majority of medical resources have moved out of Houston's NRG Stadium to support patient evacuation and patient care operations in Beaumont and Orange County, where a mobile medical unit (MMU) is expected to arrive Saturday. 

New Walmart, Sam's, and Brookshire pharmacy contracts are in place to provide medications in the affected areas, officials say. Three medical shelters are open, though few evacuees remain at those facilities: As of Friday morning, San Antonio had 39 evacuees, Austin had nine, and NRG Stadium had one.

About 1,100 patients have been evacuated or transferred from affected areas, and three MMUs have treated 320 patients, 53 of which have been transferred to hospitals, officials say.

Helpful Links, Resources, and Information on Hurricane Harvey

Over the past week, TMA has sent daily Action newsletters offering information that physicians working in areas affected by Harvey would need. Below are links to those stories and more. 

More information on Hurricane Harvey recovery can be found on the TMA's Disaster Preparedness & Response Resource Center.

Physicians looking for more information on Hurricane Harvey can email the TMA Knowledge Center or call (800) 880-7955 or (512) 370-1544. 

Physicians who wish to volunteer should register at the Texas Disaster Volunteer Registry or contact the American Red Cross

The Texas Department of Insurance (TDI) has information for injured employees, health care providers, and workers' comp carriers. TDI also has an online guide for homeowners on filing claims, deadlines, and resources

The Department of Health and Human Services website contains information on HIPAA and Public Health as well as HIPAA and Emergency Preparedness and Response

The Department of State Health Services website also contains information on Harvey disaster relief as well as Laboratory Specimen Handling and Newborn Screening Guidance.  

The New York Times has published a Q&A on Health Threats From Hurricane Harvey.

 TMAIT Action Ad 6.15

The "Hidden Crisis" of Coverage Denials

When insurance companies say "no" — whether through prior authorization requirements, step therapy programs, or nonmedical switching policies — covered patients find … well … they don't have the coverage they need. A new survey finds this "hidden health care crisis" hits tens of millions of Americans.

"The real crisis is among patients with chronic illnesses who tell us that insurance is worthless when their insurance providers withhold coverage of essential treatments prescribed by a doctor," said Stacey Worthy, executive director of Aimed Alliance and a founding member of the Doctor-Patient Rights Project, which recently commissioned a survey of insured Americans.

The survey, which can be read in full here, sought to understand the number of people affected by coverage denials for treatment of chronic or persistent illnesses or conditions.

According to the survey: 

  • Almost two out of three patients were denied coverage multiple times, and most had to wait more than a month before their insurance provider responded to a request for treatment.
  • Almost a third (29%) of patients initially denied coverage reported that their conditioned worsened, even after the insurer was persuaded to cover the treatment.
  • Thirty-four percent of patients who were denied coverage had to put off or forego treatment altogether. 

TMA worked diligently during the 2017 legislative session to limit insurance providers' role in treatment decisions in Texas. With the help of member-physicians who wrote letters and emails to their senators and representatives, as well as physician testimony, TMA helped pass into law Senate Bill 680 by Sen. Kelly Hancock (R-North Richland Hills), which further empowers physicians to override health plans' step therapy protocols. 

Also, check out the September issue of Texas Medicine, TMA's monthly magazine, for a hard look into prior authorizations, including independent review organizations and peer-to-peer conversations. Authorizations are designed to keep costs down, but Texas physicians tell TMA that in the past year or so, prior authorizations have become abusive.

Expanded HIV Testing Recommended as Clusters Grow

Let's talk about sex, shall we?

Specifically, let's talk about what you can do as a physician to help stop 16 rapidly growing clusters of HIV infection in Texas.

That's right. In case you missed this health advisory from the Texas Department of State Health Services (DSHS), genetically similar types of HIV have been identified in 16 geographic clusters, largely centered in Houston, San Antonio, and the Dallas-Fort Worth metroplex. However, many of these clusters include one or more people who live in other parts of the state, and cases are spread across more than 25 counties.

The clusters are primarily made up of gay men or men who have sex with other men, many of whom are meeting through social media, DSHS said. But, of course, these are not the only groups at risk, and it is likely that additional cases and clusters may arise.

So what should you do?

Well, the health department requests the following:

  • Order HIV testing for patients with symptoms of possible acute HIV infection.
  • Order NAAT or HIV RNA testing for patients with an indeterminate supplemental HIV test result.
  • Order HIV testing for all patients diagnosed with a sexually transmitted disease (STD).
  • Ensure all HIV testing follows CDC's HIV/AIDS Laboratory Testing Guidance.
  • Discuss pre-exposure prophylaxis (PrEP) with HIV-negative patients at increased risk of infection. (Read "A Preemptive Weapon" from the November 2016 issue of Texas Medicine for more on PrEP.) 

For more information, call the DSHS HIV/STD Program at (512) 533-3000 or the National Clinicians Consultation Network at (800) 933-3413.

More Rio Grande Counties Added to Zika Testing List

Summer ain't over yet — so neither are the mosquitoes nor the news on Zika.

The Texas Department of State Health Services (DSHS) added three more counties (Kinney, Maverick, and Val Verde) to the places in Texas where it recommends routine Zika virus testing for pregnant women.

Cameron, Hidalgo, Starr, Webb, Willacy, and Zapata counties were already on the list. If you're unfamiliar with the counties on the list (and nobody expects you to know where all 254 counties in Texas are), note that most sit along the Rio Grande.

"This nine-county area is at a higher risk of Zika spreading by mosquitoes because of its climate and geography," DSHS said in the alert. "Reports out of Mexico show local Zika transmission continues to occur in some states and communities on the Mexican side of the border."

DSHS also is changing the number of times physicians should test women in these higher-risk areas to three times during pregnancy, rather than two.

So here's what this means if you treat patients in the nine counties on the list: 

  • Test pregnant women three times during pregnancy for Zika.
  • Test anyone else who has an itchy rash plus one other common Zika symptom: fever, joint pain, or eye redness. 

If you live anywhere else, continue to watch out for Zika in your patients and use your clinical judgment if you believe somebody should be tested. 

Now here's a little good news: "There's no evidence of ongoing Zika transmission anywhere in Texas," DSHS said.

However, "Texas is entering peak season for mosquito-borne disease, and people statewide should continue to protect themselves from mosquito bites by consistently using mosquito repellent when outside, wearing long sleeves and pants, and using air conditioning or making sure door and window screens will keep mosquitoes out of the home."

So there ya go. Use your best judgment, and continue to provide the excellent care you always have.

And if you want more information, you can't do any better than TexasZika.org and TMA's Infectious Diseases Resource Center.

 Action TMLT Ad 10.15

Champions Are Made; HPV Vaccine Champions Are Nominated

You can't be a champion unless you practice. That's true in sports, but is there a way for a clinical practice to be a champion?

There certainly is, if your practice or one you know has been particularly successful in vaccinating against human papillomavirus (HPV) or in increasing parents' acceptance of the vaccine for their children.

Nominations are being accepted for a national award program associated with the National Center for Immunization and Respiratory Diseases' HPV Vaccine Is Cancer Prevention campaign.

The "HPV Vaccine Is Cancer Prevention" Champion Award Program will recognize "leaders in health care whose vaccination rates demonstrate their commitment to preventing HPV cancers through timely vaccination of adolescents," the Centers for Disease Control and Prevention (CDC) said in announcing the awards.

You can nominate either your practice or one you know, but you have to do so quickly: Submissions must be emailed by Sept. 15.

The CDC’s website has plenty of details about the award — including ways to nominate and guidelines for submissions. It also has more details about the "HPV Vaccine Is Cancer Prevention" campaign.

While we're on the subject of HPV, check out TMA's HPV Resource Center, where you'll find information about the vaccine, ways you can help increase vaccination rates, and a trove of state and national HPV resources.

Set Your Office Up With Supplies Using TMA Group Vendor Office Depot

You've got an office, and it needs supplies. But buying pens, paper, and all those tiny staples adds up.

Well here's some good news: You can save plenty of money on everything your office needs thanks to TMA's group vendor Office Depot. TMA members, family, and friends get a discount at Office Depot, including an additional 15 percent off if you're shopping online. Just use TMA's coupon code 50591873 at checkout. 

I know you're thinking there's no way this can get any better, but check this out: Orders over $50 are delivered the next day with free shipping! To get the discount at Office Depot locations, visit this webpage to print the TMA-branded store purchasing card, which you can laminate for free at an Office Depot location. 

Check out other ways your TMA membership saves you money by visiting the Endorsed Vendors and Group Discount Program page on our website. Be sure to mention your TMA membership to receive member rates and the best service.

20-Percent Discount on LED Bulbs and Fixtures for TMA Members

Look up for a second. You see the lights in your building? Are they those old fluorescent fixtures, or has your practice moved into the 21st century by switching to energy-efficient LEDs?

If you're a physician who owns or manages your practice space, it’s possible you've already considered converting to LEDs.

But if you're still on the fence about LEDs, here are at least two reasons to switch:

  1. LED fixtures save money over time because they use less energy and last longer.
  2. LEDs emit less heat so your air-conditioning usage also will go down. 

If you're still not convinced, let me give you one more incentive: TMA is pleased to announce a newly approved group discount program vendor, Demand Lighting, a manufacturer direct supplier of commercial LED lighting.  

What that means is that physician-members who switch to LED using Demand Lighting will receive a 20-percent discount on all lighting and fixtures you buy (however, any labor required for installation cannot be discounted). Furthermore, members located in certain markets may be eligible for energy rebates or other incentives. 

If you're interested in receiving a free assessment and proposal for services, you should contact Demand Lighting to get started.

Want more information? Check out www.DemandLighting.com/TMA

And don't forget to visit the TMA Group Discount Program page for information on other discounts provided as a benefit of your TMA membership. 


   PC Action Ad Oct 13

You've Mastered the Art of Medicine. Next Up? Help With Business

Have you heard the adage that healing is an art, medicine a profession, and health care a business? 

Now, you and I have no doubt that you've mastered the healing and the medicine, but how are your business skills?  

No matter how you answered, TMA's Business Skills Benefits can help you address any operational challenges you might face — whether you're just starting your own practice or you're a seasoned pro. 

By focusing on three key principles of business success — leadership, teamwork, and data analytics — TMA provides members with objective resources and the valuable instruction often omitted in medical school. We're talking useful stuff like: 

  • Our handbooks on employment contracts;
  • Help challenging inaccurate insurance company rankings; and
  • Getting ready for retirement with template letters and checklists. 

All of that and so much more is available on our website. It's just one of the many ways your TMA membership works for you.

This Month in Texas Medicine

The September issue of Texas Medicine takes an in-depth look at prior authorizations, which insurance companies require when physicians prescribe a medication or treatment. Authorizations are designed to keep costs down, but anecdotal evidence shows that in the last year or so, prior authorizations have become abusive. Topics include independent review organizations, which offer a little-known appeal, and peer-to-peer conversations between a patient's physician and another physician to determine whether the treatment is necessary. The magazine also looks at long-term effects of adverse childhood experiences, a legal case involving pharmacies and compounding creams, and The University of Texas Rio Grande Valley School of Medicine, which opened about a year ago.

Check out our digital edition

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. 

CMS Quality Payment Program Deadlines  

10/2
Last 90-Day Period for the 2017 MIPS Performance Year

12/31
Last Day of the 2017 MIPS Performance Year

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

Innovation in Education for Cardiovascular Risk Patients: Heart Healthy Diet and Lifestyle

Making Discussions About Death and Dying Easier

HIPAA Training for Medical Office Staff

About Action       

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

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

To unsubscribe from Action, email TMA's Communication Division at tmainfo[at]texmed[dot]org.

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 the Action editor.

Last Updated On

September 05, 2017