TMA Young Physicians Memo

Summer 2017  

Simple Steps to Strong Leadership

The Texas Medical Association Young Physician Section (YPS) was honored to have Angela Siler Fisher, MD, share tangible steps to improve networking and leadership skills at TexMed 2017 in May in Houston. 

During her talk, Dr. Fisher overviewed what she calls “the foundation of leadership development.” 

Dr. Fisher is an emergency medicine physician in Houston and founder of MaveRx, a leadership development consulting firm.

She suggested the following steps to ensure success in every project: 

  • Step 1: Start with the end in mind! Write down your goals then network and formalize mentorships with those you wish to emulate. These mentors will help create your roadmap to success. 
  • Step 2: Establish credibility. Reach out for opportunities to work with your mentors, apply for leadership roles, and run for elected positions. The American Medical Association, state medical associations, state specialty societies, county medical societies, medical schools, and residency programs all offer leadership opportunities. 
  • Step 3: Work with your mentors to identify opportunities to ensure acknowledgement of individual and team successes through nominations for awards. There are awards available for everyone — just look for them!  

More leadership information and resources can also be found through the TMA Knowledge Center.

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Deadline Looming to Comply with Medicaid Enrollment Requirement

What are you doing this summer? Planning a trip? Relaxing by the pool? Just going to keep working?

That all sounds good. 

But if you or your practice orders or refers for Medicaid patients — even if you do not otherwise participate in Medicaid — here’s something you better do: Enroll in Medicaid before Oct. 1.

If you already have a Medicaid provider number or have already enrolled as an ordering and referring-only practice, you’re way ahead of the game.

If you haven’t, you’d better get on it. Enrollment is required under the Affordable Care Act, and the Oct. 1 deadline will be here before you know it. Enrollment applies to physicians, advanced practice registered nurses, physician assistants, and other health professionals and providers. 

It also applies to physicians who only care for dual-eligible patients — those who are eligible for Medicare and Medicaid — and who order Medicaid-only services for those patients (the requirement does not apply to crossover claims). If that’s you, you must enroll as an ordering and referring physician.

Visit the Texas Medicaid and Healthcare Partnership (TMHP) website for more information. 

If you’re a physician whose only relationship with Texas Medicaid is to order or refer services to Medicaid clients, TMHP has developed an abbreviated enrollment application, which you can find here.

But wait, there’s more. 

If you’re submitting a claim for services that require an order or a referral, you must include the National Provider Identifier (NPI) of the ordering, prescribing, or referring provider on the claim.

Furthermore, residents and interns at your practice will be able to order and refer using the supervising physician’s NPI, or they can use their own if they have one.

After Oct. 1, Medicaid patients who attempt to fill a prescription will be unable to do so if the ordering and referring physician or provider is not enrolled. Other examples of services that require an order or referral include:  

  • Clinical, radiological, or laboratory services;
  • Home health agency services;
  • Durable medical equipment (DME);
  • Eyeglasses; and 
  • Hearing aids.  

The requirement applies for patients enrolled in either Medicaid managed care or fee-for-service. 

Enroll now so you can have a beach umbrella hanging over your head this summer instead of a deadline. If you have questions, call TMHP at (800) 925-9126.

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Houston Hospital Denies Physicians Voted to Remove MOC

A new law to stop maintenance of certification (MOC) oppression against Texas physicians hasn't even taken effect yet, but a Houston hospital is already pushing back against physicians who want to avail themselves of the protections in the TMA-backed measure.

During a general medical staff meeting June 27, attending physicians at Memorial Hermann Hospital Southeast voted unanimously to recommend that MOC requirements be removed systemwide. Memorial Hermann Health System bylaws require that any changes be approved by the active medical staff at all 16 of its hospitals.

“The message here is that every Memorial doctor needs to wake up and vote it out because that’s what the law says,” urologist Ori Hampel, MD, said, referring to Senate Bill 1148, a new law aimed at cracking down on what many Texas physicians see as “MOC abuse.” 

The bill, written by Sen. Dawn Buckingham, MD (R-Lakeway) and co-sponsored by Rep. Greg Bonnen, MD (R-Friendswood), will prevent the Texas Medical Board from using MOC as a requirement for doctors to obtain or renew a medical license. It also bars hospitals and health plans from requiring physicians to obtain MOC for credentialing or contracts. A hospital may require MOC only with an affirmative vote from its medical staff. It was signed by Gov. Greg Abbott in June and will take effect Jan. 1.

“The legislature did their job, Doctors Buckingham and Bonnen did their jobs, now all of us need to take back the autonomy we gave up when we allowed MOC,” Dr. Hampel said. “We need to vote it out of every bylaws in the state.”

Although other prominent Houston physicians at the meeting confirmed Dr. Hampel's accounts of what happened, a spokesperson for Memorial Hermann Health System says otherwise.

"There is no official, formal vote on record that recommends this requirement," Kathryn Williams said in an email to TMA.

Speaking to TMA, Senator Buckingham encouraged all doctors “to push to remove these outdated and unnecessary requirements from hospital bylaws. It is time for doctors to take back their profession and fight for quality care that best serves their patients.”

TMA strongly supported SB 1148, which TMA President Carlos J. Cardenas, MD, said prevents physicians from dealing with an "unnecessary — and very costly — distraction.”

“The MOC and all of its requirements have been taking physicians away from caring for their patients as they’ve performed tasks and studied for trivial exams that do not reflect their scope of practice,” Dr. Hampel said. “Additionally, the most qualified and experienced physicians time their retirements based on their MOC cycle, which removes physicians who would be happy to continue caring for Texans out of the physician workforce.”

During the legislative session, nearly 1,400 TMA members sent lawmakers 2,300 emails in support of the bill using the TMA Grassroots Action Center.

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Get Tech Help Online from TMA

Technology. It’s changed our lives in so many ways: You can now program your television with your phone, turn on the porch light when you’re at dinner, you can even have your refrigerator tell you when it’s running low on food.

But let’s face it, technology can present plenty of challenges, especially when it comes to medical billing, coding, and other processes your practice needs.

Thankfully, TMA works diligently to give you the tools to tackle these challenges. Need help selecting an electronic health record (EHR) or understanding the Medicare Access and CHIP Reauthorization Act (MACRA) program? Can’t figure out the EHR incentive program? Need information on e-prescribing? TMA has you covered. 

You can find links to all of these tools on the technology page of the TMA website. 

Here’s some of the many resources TMA has to offer:  

  • EHR Product Evaluation Tool: This tool, for members only, compares the most-used EHRs in Texas by functionality and pricing.
  • MACRA Resource Center: Whether you’re just trying to meet the minimum requirements to avoid the penalty, or you’re looking to maximize your incentive payment, here’s where you’ll find the latest MACRA program information, resources, CME, and consulting options.
  • Advancing Care Information (ACI) Resource Center: Learn what you need to do to meet the ACI objectives and measures for the Merit-Based Incentive Payment System (MIPS). You can also find out about ACI scoring, reporting options, and what you need to have in case of an audit. 
  • EHR Buyer Beware: Issues to Consider When Contracting with EHR Vendors: This paper discusses eight important EHR contract terms you should consider before signing an EHR contract.
  • EHR Incentive Program Resource Center: The Medicaid EHR Incentive Program continues until 2021. Stay in-the-know about program updates so you don’t miss out on the incentive payments.
  • E-Prescribing Resource Center: Benefits of e-prescribing include medication reconciliation, medication history, eligibility, and formulary information. Visit the resource center for help with e-prescribing. 
  • Ransomware and Cyber Security Resource Center: Ransomware has reached Texas, and it teaches us all why it’s so important to keep our security systems up-to-date. Use this resource center to access articles and education on cyber security and ways to protect your practice.  

You can even check out this handy print-out, which lists the online TMA Technology tools and the web links. 

If you have questions about these health information technology (HIT) tools and resources or if you need additional help, contact the TMA HIT Helpline at (800) 880-5720 or by email

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Need TMAF Grant Support? Deadlines Approaching!

Let’s jump in the way-back machine and travel to … 2016.

Last year, the Paris-Lamar County Health District partnered with the Lamar-Delta County Medical Society, along with other community groups, to give 360 flu shots to drivers and passengers at a "Drive Thru, Prevent the Flu" initiative.

At about the same time, The University of Texas Medical Branch at Galveston worked with area organizations to provide flu vaccines to underserved and uninsured residents of Galveston and surrounding counties.

Think about that: Hundreds of Texans who might not otherwise have received flu vaccines were protected against the virus thanks to the work of a county medical society and a student chapter.

"That’s amazing," you say. "How'd they pull that off?"

Well, they got financial help in part through the TMA Foundation's Medical Community Grants and Medical Student Leadership Grants programs. 

Now, let's start thinking about the future. Encourage your TMA county medical society or alliance student chapter to apply for a grant to support a community health improvement initiative that you, your colleagues, and community partners want to carry out. 

There are two deadlines to apply for this year's grants: Aug. 15 and Dec. 15. County societies and alliance chapters may apply for up to $7,500. More information, including how to apply, can be found on the TMA Foundation webpage.  

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Texas Stands Tall in AMA House

Texans won big, in both political and policy arenas, at the annual meeting of the American Medical Association House of Delegates.

More than 100 Texas physicians, residents, medical students, and alliance members representing the Texas Medical Association, various sections, and national specialty societies participated in the June 10-14 meeting in Chicago. 

The Texas delegation left the meeting having elected both candidates it ran for AMA office and winning adoption of several Texas policy statements.

Among the most hotly contested issues were AMA’s stance on proposed changes to Medicaid funding and the imposition of maintenance of certification (MOC) requirements on physicians.

No Medicaid Block Grants
The House of Delegates adopted a simple statement that AMA opposes caps on federal Medicaid funding, a key financing provision in congressional Republicans’ plan to repeal and replace the Affordable Care Act. 

“Capping Medicaid funding would be disastrous for patients by limiting medical responses to unforeseen events and medical innovations,” AMA Board of Trustees Member Carl A. Sirio, MD, said after the vote. “Physicians and states need the flexibility to respond.”

But, led by Fort Worth pediatrician Melissa Garretson, MD, delegates rejected a proposal for AMA to advocate a nine-point set of principles should Congress move ahead with a Medicaid cap. Dr. Garretson and others argued successfully that AMA should not “show its hand” in the face of heated debate on health system reform.

Physicians expressed their continued outrage at mandatory MOC requirements and at the national boards that administer the certification programs. Long lines of delegates queued at the reference committee microphones to debate MOC with physicians representing the American Board of Medical Specialties (ABMS) and other boards.

Two days later, the house unanimously adopted the reference committee report, which called for:

  • Recognition that “high quality continuing medical education (CME) appropriate to that physician’s medical practice” is the best approach to lifelong learning for physicians;
  • The elimination of high-stakes examinations in MOC;
  • ABMS to continue to display publicly a physician’s initial board certification status even if the physician chooses not to participate in MOC;
  • Further studies of how AMA can help state medical societies lobby for laws — such as recently passed by the Texas Legislature — that bar state licensing boards, hospitals, and insurance companies from requiring MOC; and
  • Further study of a proposal to oppose ABMS direct-to-consumer marketing that links MOC participation with improved health outcomes.

Texans, Texas Ideas Triumph
The Texas Delegation arrived in Chicago with the goal of electing two members to AMA office and winning approval of three policy items passed earlier this year by the TMA House of Delegates. They were overwhelmingly successful.

On the first day of the meeting, former TMA President Sue Bailey, MD, of Fort Worth, was unanimously re-elected to her third term as speaker of the house. 

Dallas public health physician John Carlo, MD, a newcomer to AMA politics, won one of two open seats on the AMA Council on Science and Public Health. Dr. Carlo campaigned on his experience as a former Dallas County health officer and his leading roles in helping Dallas combat West Nile virus and the 2014 Ebola outbreak.

Former TMA President Bob Gunby, MD, was elected vice chair of the Organization of State Medical Association Presidents.

Plastic surgeon Susan Pike, MD, was elected to the governing board of the AMA’s Integrated Physician Practice Section. Dr. Pike is the director of the Cosmetic Surgery Center at Baylor Scott & White’s Round Rock campus.

All three of the policy proposals Texas took to the meeting won support from the house.

  • One directs AMA to push the Centers for Medicare & Medicaid Services (CMS) for flexibility beyond the current maximum of five years on the graduate medical education (GME) cap-setting deadline for new residency programs. This will especially help GME programs in medically underserved areas.
  • The second tells AMA to ask that CMS create an exception to the current regulation that says physicians can bill locum tenens for no more than 60 days. The exception to the 60-day limit would apply to physicians facing illnesses, family emergencies, or prolonged absences after childbirth.
  • The third Texas resolution called on AMA to adopt minimum federal standards for the sale of health insurance across state lines, another policy proposal under consideration in Congress. Rather than put off action on this politically hot issue, the house voted for a specific set of standards. The adopted policy states that any legislation allowing cross-border insurance sales should not weaken any state’s protections on key issues such as network adequacy, contracting, prompt payment, and appeals.

“The Texas Delegation to the AMA is composed of leaders from Texas that advocate and promote issues important to Texas physicians at the national level,” said David Henkes, MD, of San Antonio, chair of the Texas Delegation. “The number of Texas delegates is based on the number of AMA members in Texas. We encourage your membership in AMA so that the voice of Texas can be increased and heard louder at the national level.” 

Other Issues Merit Action
Delegates addressed various other economic, legislative, and organizational topics. The house:

  • At the recommendation of the Texas delegation and Austin ophthalmologist Michelle Berger, MD, revamped proposed policy on out-of-network billing to ensure it doesn’t contradict recent gains physicians won in the 2017 Texas Legislature;
  • Said CMS should revise and simplify the Medicare and CHIP Reauthorization Act (MACRA) rules to ease the regulatory burden on physicians;
  • Voted to strengthen AMA policy against sugar-sweetened beverages and to back state medical societies who are pushing state legislators to tax those drinks;
  • Adopted new policy that encourages “state medical boards to recognize that the presence of a mental health condition does not necessarily equate with an impaired ability to practice medicine;”
  • Said AMA should work for continued improvements to the Veterans Choice Program and better sharing of veterans’ medical records among physicians in and out of the Veterans Administration;
  • Called for opposing laws that would deny entry or re-entry to the United States of international medical students and international medical graduates who are in the country legally; and
  • Adopted several resolutions advocating for better health care services for families held in immigration detention centers.  

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Join Us at Fall Conference

Register for the 2017 TMA Fall Conference, which will take place Sept. 15-16 at the Hyatt Regency Lost Pines Resort & Spa in Bastrop. This free member benefit lets you reconnect with colleagues and learn more about what’s new in Texas health care. This year’s programming will feature a recap of the 85th Legislative session. It also will include a discussion of the long- and short-term effects of abuse and neglect and other adverse childhood experiences.

The YPS will host a casual mixer with the Resident and Fellow Section at 8 pm on Fri., Sept. 15, with a joint business meeting to follow at 9 pm. Visit the YPS webpage for upcoming meeting details and agenda. 

TMA’s special room rate is $214 plus tax and a $5 resort fee for single or double occupancy. Reserve a room online or by calling (888) 421-1442, and ask for the TMA Fall Conference rate. The deadline to book your hotel reservation at the TMA rate is Aug. 30.  

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Last Updated On

February 25, 2021

Originally Published On

March 23, 2010

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