Texas Doctors Seek Red-Tape Reduction to Help Patients in Need

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 disabilities move.

The 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 know.

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 without care.

“Those 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.”

Against 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.

“One of 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.

In 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.

The 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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Last Updated On

June 07, 2018

Originally Published On

June 07, 2018

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