June 7, 2018
A group of Texas physicians is fighting government
roadblocks to secure care and services to help their patients in need — to
access addiction-fighting drugs, or obtain devices to help people with
34-member Texas Delegation to the American Medical Association (AMA) House of
Delegates will ask the policymaking body to adopt a resolution this week to
help patients with disabilities get devices to help them move, and another to
allow physicians to prescribe medications electronically for patients they
Custom-powered wheelchairs and adaptive seating,
custom-configured for patients with chronic and disabling conditions, are
called complex rehabilitation technology devices. Right now, the Centers for
Medicare & Medicaid Services classifies those devices as durable medical
equipment, lumping the special devices with others. Doctors say without these
devices having their own Medicare payment category, too often patients cannot
get them when they need them.
“[Patients] need power wheelchairs and custom manual
wheelchairs that they can’t get because of multiple hoops they have to jump
through,” said Ellia Ciammaichella, DO, a member of the Texas Medical
Association’s (TMA’s) Resident and Fellow Section of physicians in training.
The group sponsored a resolution at TMA’s House of Delegates directing the
Texas AMA group to propose the change at the national level. The draft AMA resolution says
the reclassification would “increase (patients’) independence, reduce their
overall health care expenses, and appropriately manage their medical needs.”
The other proposal aims to change AMA policy to
support letting psychiatrists e-prescribe strictly controlled medications to
patients with whom a telemedicine relationship has been established. A prime
example would be a psychiatrist trying to help her rural Texas patient
struggling with opioid addiction, miles away from her. The psychiatrist could
use telemedicine to counsel the patient and prescribe the medication he needs,
but U.S. Drug Enforcement Administration (DEA) regulations on e-prescribing are
vague and could leave that treating physician in legal jeopardy. The proposal, recently
approved by TMA’s policymaking body, is designed to remove legal ambiguities at
the federal level created by DEA rules and a law, the federal Ryan Haight Act.
Without the change, that patient and many others like him too often must go
laws were originally made in order to prevent internet pill mills from
distributing pills without meeting a standard of care and establishing a good
doctor-patient relationship,” said Austin psychiatrist Elizabeth Truong, MD,
who wrote the initial proposal. “There’s a lot of nervousness out there by
physicians because they want to protect their DEA and their board license on
prescribing controlled medicines.”
those legal barriers, the physicians struggle to help their patients. TMA’s
policy urges AMA to push the government to allow doctors already treating the
far-away patients to use telemedicine to legally prescribe and care for them.
the biggest [issues] is the opioid crisis,” Dr. Truong said. “There are very,
very few prescribers here in Texas who can prescribe things like Suboxone [an
opioid used to treat opioid addiction] or feel comfortable with
medication-assisted therapies. To be able to get care to a lot of these rural
counties where there aren’t psychiatrists, period, to do any kind of
medication-assisted therapy is really, really tough.” She said telemedicine is
a simple, tried-and-true solution, especially for psychiatrists, who are in
chronic short supply in Texas.
2017, the Texas Legislature — with TMA’s support — passed a law to create a
more clear-cut legal framework for telemedicine to operate in Texas.
Texas Delegation physicians will introduce both policy proposals at the AMA
House of Delegates annual meeting this weekend in Chicago.
TMA is the
largest state medical society in the nation, representing more than 51,000 physician
and medical student members. It is located in Austin and has 110 component
county medical societies around the state. TMA’s key objective since 1853 is to
improve the health of all Texans.
Brent Annear (512) 370-1381; cell: (512) 656-7320; email: brent.annear[at]texmed[dot]org
Marcus Cooper (512)
370-1382; cell: (512) 650-5336; email: marcus.cooper[at]texmed[dot]org
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