tag:blogger.com,1999:blog-131461432021-01-02T22:03:06.855-06:00Blogged Arteries<i>Blogged Arteries</i> provides the Latest Member News <br>from the Texas Medical Association, <br>America's Largest State Medical SocietySteve Levinehttp://www.blogger.com/profile/05032341081521706316noreply@blogger.comBlogger1191125tag:blogger.com,1999:blog-13146143.post-27115284940335789722017-11-15T18:36:00.000-06:002017-11-15T18:36:09.775-06:00A Texas Stance Against Resistance<b><i>Michael P. Fischer, MD</i></b><br />
<b><i>Infectious Disease Control Unit</i></b><br />
<b><i>Texas Department of State Health Services</i></b><br />
<br />
<i>Editor’s Note: Nov. 13-19 is Antibiotic Awareness Week. The following post discusses adherence to evidenced-based antibiotic stewardship programs.</i><br />
<br />
The use of antibiotics is the single most important factor leading to antibiotic resistance around the world. In the United States, the Centers for Disease Control and Prevention estimates more than 2 million people are infected with antibiotic-resistant organisms, and approximately 23,000 of these infections result in death annually. Evidence-based practices and policies are effective in stopping outbreaks and eliminating persistence of antimicrobial-resistant organisms. However, for these prevention efforts to be longstanding and across all spectrums of health care, the continued use of and adherence to evidenced-based antibiotic stewardship programs is critical.<br />
<br />
In U.S acute care hospitals, it is estimated that 20 percent to 50 percent of all antibiotics prescribed are either unnecessary or inappropriate. The promotion of evidence-based antibiotic stewardship programs, which have been shown to improve individual patient outcomes, reduce overall burden of antibiotic resistance, and decrease health care costs, is good medical practice.<br />
<br />
In concert with the promotion of antibiotic awareness this week, the Texas Department of State Health Services (DSHS), Emerging and Acute Infectious Disease Branch, has created a new position in its Healthcare Safety Group, that of Texas antibiotic stewardship expert. I am honored to hold that position, where my charge is to help combat antibiotic resistance through education and distribution of materials focused on developing and enhancing antibiotic stewardship programs in all health care settings and communities across Texas.<br />
<br />
DSHS’s first antibiotic stewardship initiative is aimed at preventing patient harm from unnecessary antibiotic use in treatment of asymptomatic bacteriuria in long-term care facilities (LTCFs). This initiative supports awareness of asymptomatic bacteriuria, implementation of policies and best practices for ordering culture and sensitivity tests for patients with signs and symptoms of urinary tract infection (UTI), and communication of these test results with antimicrobial therapy review (i.e., antibiotic time-out) in a timely fashion.<br />
<br />
DSHS chose this topic and spectrum of health care facilities because antibiotics are among the most commonly prescribed medications in nursing homes. In addition, up to 70 percent of nursing home residents have received at least one course of a systemic antibiotic in a year, and some studies have shown that 40 percent to 75 percent of the antibiotics prescribed in LTCFs may be unnecessary or inappropriate. Many commonly prescribed have been associated with complications, such as diarrhea from Clostridium difficile, which can be more severe and difficult to treat, and lead to more hospitalizations and deaths among people over 65 years old. By improving the diagnosis and treatment of UTIs in LTCFs, we can see a significant reduction of inappropriately prescribed antibiotics, antibiotic-associated adverse events, and antibiotic resistance.<br />
<br />
In addition to the creation of the antibiotic stewardship expert position, the Texas DSHS’s Laboratory Services Section has been designated as one of the seven regional laboratories in the nation that make up the <a href="https://www.cdc.gov/drugresistance/solutions-initiative/ar-lab-networks.html" target="_blank">Antibiotic Resistance Laboratory Network</a>. The laboratory performs core testing for the mountain region of the United States (a zone that includes Texas). The lab currently is focused on carbapenem-resistant Enterobacteriaceae characterization and outbreak support, aiding in the salmonella whole genome sequencing program, and detecting new resistant organisms and resistance mechanisms/genes.<br />
<br />
This is an exciting addition to DSHS and a wonderful resource for providing Texas’ physicians, health care providers, and communities with information necessary to strengthen their antibiotic stewardship programs and further limit the development and spread of antibiotic resistance in the state.<br />
<br />
If you have any questions or comments, please email <a href="mailto:HAITEXAS@dshs.texas.gov">HAITEXAS@dshs.texas.gov</a>.<br />
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<b>Footnotes</b></div>
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<div>
<span style="font-size: x-small;">1. CDC. Antibiotic resistance threats in the United States. Atlanta, Ga.: U.S. Department of Health and Human Services, CDC; 2013. <a href="http://www.cdc.gov/drugresistance/threat-report-2013/">www.cdc.gov/drugresistance/threat-report-2013/</a></span></div>
<div>
<span style="font-size: x-small;">2. CDC. Core Elements of Hospital Antibiotic Stewardship Programs. Atlanta, Ga.: U.S. Department of Health and Human Services, CDC; 2014. Available at <a href="http://www.cdc.gov/getsmart/healthcare/implementation/core-elements.html">www.cdc.gov/getsmart/healthcare/implementation/core-elements.html</a>.</span></div>
<div>
<span style="font-size: x-small;">3. Dellit TH, Owens RC, McGowan JE Jr., et al. Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship. Clinical Infectious Diseases: an official publication of the Infectious Diseases Society of America. Jan. 15 2007;44(2):159-177.</span></div>
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<div>
<span style="font-size: x-small;">4. CDC. The Core Elements of Antibiotic Stewardship for Nursing Homes. Atlanta, Ga.:</span></div>
<div>
<span style="font-size: x-small;">U.S. Department of Health and Human Services, CDC; 2015. Available at:</span></div>
<div>
<span style="font-size: x-small;"><a href="http://www.cdc.gov/longtermcare/index.html">www.cdc.gov/longtermcare/index.html</a>.</span></div>
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<div class="blogger-post-footer">http://feeds.feedburner.com/bloggedarteries</div>Me and My Doctorhttp://www.blogger.com/profile/14771175740273059876noreply@blogger.com0tag:blogger.com,1999:blog-13146143.post-28773458966375435022017-09-27T12:58:00.001-05:002017-09-27T12:58:53.633-05:00Medical Considerations Behind Emotional Support Dogs<a href="https://4.bp.blogspot.com/-OfISSRGc3Pk/WcvmRFGh9-I/AAAAAAAAAko/8z7p2hxyXh8VeMB2HBHcGHo3VCchIPWXQCLcBGAs/s1600/GRC9511-James%2BGuy%2BBaker%252C%2B%2B%2B-%2B32970%2BP2.JPG" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="1600" data-original-width="1280" height="200" src="https://4.bp.blogspot.com/-OfISSRGc3Pk/WcvmRFGh9-I/AAAAAAAAAko/8z7p2hxyXh8VeMB2HBHcGHo3VCchIPWXQCLcBGAs/s200/GRC9511-James%2BGuy%2BBaker%252C%2B%2B%2B-%2B32970%2BP2.JPG" width="160" /></a><i><b>By James G Baker, MD</b></i><br />
<i><b>Member, TMA Council on Science and Public Health</b></i><br />
<br />
If a patient asks you to sign a letter supporting his emotional support dog, should you do it?<br />
<br />
For a canine to be designated as someone’s emotional support dog, the person seeking such an animal must have a note from a physician or other medical professional stating that (1) the patient does have a psychiatric disability, and (2) the emotional support animal provides a benefit for the patient beyond the simple need for companionship. The most common reason for the letter request is that emotional support dogs legally are viewed as a “reasonable accommodation” in apartments that have a “no pets” rule.<br />
<br />
The idea of using a dog as emotional support would seem to make perfect sense. After all, who wouldn’t benefit from having a four-legged friend at his or her side? Assuming you are the patient has a disability, here are a couple of considerations when assessing the benefit to your patients.<br />
<br />
<div style="text-align: left;">
</div>
First, while there is good research showing the benefits of service assistance dogs for people with physical disabilities, there is little evidence for the use of service assistance dogs, let alone emotional support dogs, in mental illness. How are service dogs and emotional support dogs different? Service dogs are trained intensively by professionals for many months to perform specific tasks for people with disabilities. For example, service dogs are trained to open doors and turn on lights for people with physical disabilities. They might serve as ears for the hearing-impaired or as eyes for the visually impaired. Service dogs can also be trained as skilled companions for people with intellectual disabilities or mental illness. By contrast, an emotional support dog is not trained to do any specific tasks related to a disability, but rather provides a therapeutic benefit to its owner through companionship.<br />
<br />
Second, the lack of specific training requirements for an emotional support dog is problematic. Hopefully the patient’s dog is friendly, calm, and without unexpected behaviors, especially in public. But due to the lack of training, an emotional support dog may bark, act aggressively if it feels threatened, or be intrusive of others in public. By contrast, a service dog is trained to ignore distractions and cause minimal imposition to its surroundings. At very least, an emotional support dog should have formal obedience training sufficient to obtain a canine good-citizen certificate, but longer-term obedience training would be even better. Ideally, the dog would be a skilled-companion service dog trained in skills and tasks to help mitigate the patient’s specific disability.<br />
<br />
Hopefully in the not-too-distant future there will be an evidence basis for recommending emotional support dogs for people living with mental health challenges. For example, the Department of Veterans Affairs is participating in a three-year study to compare service dogs and emotional dogs in the management of post-traumatic stress disorders. But until there is evidence to support the use of dogs, it is important to steer patients towards treatments that show evidence-based benefit for their specific challenges.<br />
<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://4.bp.blogspot.com/-5F00knz3qRU/WcvlPcEVBXI/AAAAAAAAAkk/VP3Xm8w4y-ETFTLq0VeICVq10zDQ54wmwCEwYBhgL/s1600/Peaberry.jpg" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" data-original-height="960" data-original-width="640" height="320" src="https://4.bp.blogspot.com/-5F00knz3qRU/WcvlPcEVBXI/AAAAAAAAAkk/VP3Xm8w4y-ETFTLq0VeICVq10zDQ54wmwCEwYBhgL/s320/Peaberry.jpg" width="213" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Peaberry, Dr. Baker's current <br />assistance pup-in-training.</td></tr>
</tbody></table>
<i>Dr. Baker and his wife, Janet, serve as volunteer puppy-raisers for Canine Companions for Independence, a nonprofit organization that enhances the lives of people with disabilities by providing highly trained assistance dogs at no charge to the recipient. Dr. Baker also is associate chair of clinical integration and services in the Department of Psychiatry at Dell Medical School and systems chief medical officer at Integral Care, the public mental health authority for Travis County.</i><div class="blogger-post-footer">http://feeds.feedburner.com/bloggedarteries</div>Me and My Doctorhttp://www.blogger.com/profile/14771175740273059876noreply@blogger.com0tag:blogger.com,1999:blog-13146143.post-37875100841256805072017-09-08T10:30:00.002-05:002017-09-08T10:30:15.447-05:00Physicians Can Help Stop Teen Drug and Alcohol Abuse<div class="separator" style="clear: both; text-align: center;">
<a href="https://3.bp.blogspot.com/-VLDiBTV6urg/WbFmXbNbCwI/AAAAAAAAI-M/wZOJMWz15YAWxFBdA7fJCYN6kWfT7JAeACLcBGAs/s1600/GRC9511-James%2BGuy%2BBaker%252C%2B%2B%2B-%2B32970%2BP2.JPG" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" data-original-height="1600" data-original-width="1280" height="200" src="https://3.bp.blogspot.com/-VLDiBTV6urg/WbFmXbNbCwI/AAAAAAAAI-M/wZOJMWz15YAWxFBdA7fJCYN6kWfT7JAeACLcBGAs/s200/GRC9511-James%2BGuy%2BBaker%252C%2B%2B%2B-%2B32970%2BP2.JPG" width="160" /></a></div>
<b><i>By James Baker, MD</i></b><br />
<b><i>Austin Psychiatrist</i></b><br />
<b><i>Member, TMA Council on Science and Public Health</i></b><br />
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It takes a community to prevent adolescent substance abuse, and physicians can play an important part in that community effort.<br />
<br />
While parents are the most important role models for their children, as physicians, our goal should be to help delay the age when teens first use alcohol or drugs. In addition to all of the problems related to underage drinking — sexual assaults, accidents, poor school performance — research suggests that teens who start drinking early are much more likely to have an alcohol use disorder as adults.<br />
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How can physicians help?<br />
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Prevention requires a community focus on the many risk factors that often lead to early drinking and drug use. Physicians can be mindful of these factors when they see teens in their practice. Here are some things physicians can look for and, when present, encourage teens and their parents to get help for:<br />
<ul>
<li>Family history of drug or alcohol use,</li>
<li>Family problems or disruptions,</li>
<li>Low motivation at school,</li>
<li>Behavior problems at school, and</li>
<li>Friendships with other teens with problem behaviors.</li>
</ul>
When these issues are present, doctors can encourage interventions to address them. For example, poor school performance warrants an evaluation for undiagnosed learning disorders. Family issues warrant an evaluation to see if family therapy is recommended. Motivation issues and behavior problems might indicate an underlying mood or other emerging psychiatric disorder. The local community mental health center is a good resource for all of these problems.<br />
<br />
In addition, physicians can adopt the practice of routinely screening for alcohol and drug abuse in their young patients. Screening for depression, anxiety, stress disorders, and substance use ought to be just as routine as taking vital signs. One possible screening tool is CRAFFT. CRAFFT is just six questions shown to be effective in assessing whether a referral is indicated for a longer evaluation of alcohol or drug use. CRAFFT stands for:<br />
<br />
Car (Have you been in a car with a driver — including yourself — on drugs or alcohol?),<br />
Relax (Do you use drugs/alcohol to relax?),<br />
Alone (Do you use drugs/alcohol while alone?),<br />
Forget (Do you forget things while on drugs/alcohol?),<br />
Friends (Are your friends concerned about your drugs/alcohol use?), and<br />
Trouble (Have you gotten into trouble while on drugs/alcohol?).<br />
<br />
Finally, because they are community leaders, physicians can encourage the entire community — parents, teachers, coaches, and religious and civic leaders — to give children the same messages discouraging alcohol and drug abuse, starting very early in childhood.<br />
<br />
We can help teens — and their families — avoid long-lasting consequences of alcohol and drug use through a collective and consistent message, universal screening, and early and aggressive intervention.<br />
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<i>Dr. Baker is associate chair of Clinical Integration and Services in the Department of Psychiatry at Dell Medical School and systems chief medical officer at Austin Travis County Integral Care.</i><br />
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<div class="blogger-post-footer">http://feeds.feedburner.com/bloggedarteries</div>Me and My Doctorhttp://www.blogger.com/profile/14771175740273059876noreply@blogger.com0tag:blogger.com,1999:blog-13146143.post-11353033941680147202017-08-17T15:31:00.001-05:002017-08-17T15:31:09.279-05:00Physician Viewpoint: Physician, Heal Thyself (with Help)<b><i>By </i></b><a href="https://www.austinregionalclinic.com/doctors/manish-naik">Dr. Manish Naik</a><br />
<br />
This article was originally posted on <a href="https://www.austinregionalclinic.com/about-us/leadership-blog/post/physician-viewpoint-physician-heal-thyself-with-help" target="_blank">Austin Regional Clinic's leadership blog</a>.<br />
<br />
Doctors see firsthand the toll that today’s increasingly stressful
society takes on patients: Engineers, office managers, teachers, you
name it. Work demands have increased, as has multitasking. Demands
outside the workplace add additional stress. Often parents chauffeuring
children to multiple activities must also care for aging parents with
increasing needs. Electronic devices, always in hand or close by,
command our attention (because of work or personal needs), sometimes
simultaneously. Finding a moment to catch one’s breath is as difficult
as getting enough sleep.<br />
<br />
Doctors also see stress mounting in the mirror. We struggle to keep
an even keel while facing growing demands above and beyond caring for
our patients. <a href="http://annals.org/aim/article/2546704/allocation-physician-time-ambulatory-practice-time-motion-study-4-specialties">Study</a> after <a href="http://www.medscape.com/sites/public/lifestyle/2017">study</a>, <a href="https://wire.ama-assn.org/life-career/report-reveals-severity-burnout-specialty">survey</a> after <a href="http://www.mayoclinicproceedings.org/article/S0025-6196%2815%2900716-8/abstract">survey</a>
shows that increasing responsibilities – many taking physicians’ time
away from personal interaction with patients – are taking away some of
the joy in a profession to which we have dedicated our lives and our
hearts.<br />
<br />
<strong>Overcoming ‘Paperwork’ Fatigue</strong><br />
<br />
I wouldn’t call it “burnout.” That term suggests giving up or
throwing in the towel. It’s more about having the resiliency to meet
today’s challenges. Mostly, we’re frustrated and exhausted by
administrative and clerical tasks, both in electronic and paper form,
pulling us away from our patients. Even ownership of the physician
clinical note is tainted by the regulatory burdens related to coding and
discrete data documentation for analytics and quality measurements.<br />
<br />
The challenge of resiliency needs to be a priority not only for
physicians, but the healthcare systems to which they belong. There’s no
single cause, but a lot of it is epitomized by the electronic medical
record (EMR), particularly among seasoned physicians moving well beyond
the paper records they started with at the beginning of their careers.<br />
<br />
A December 2016 American Medical Association <a href="http://annals.org/aim/article/2546704/allocation-physician-time-ambulatory-practice-time-motion-study-4-specialties">study</a>
starkly spotlighted the problem: for every hour of face-to-face time
devoted to patients, physicians spent almost two hours on EMRs and other
clerical work. With patient loads jumping and individual patient needs
rising, physicians need better tools to maintain their resiliency.<br />
<br />
Austin Regional Clinic has recognized the challenge of physician
resiliency and is trying to address it on several fronts. For example,
we have a team working full-time on optimizing EMR efficiency. Can we
cut the number of computer clicks for each task? Something as simple as
ordering a prescription – a task physicians used to do by scribbling a
note on a paper pad – can take dozens of clicks while searching through
lists of medications, dosages and more.<br />
<br />
We’re creating common order sets (called “smart-sets”), preference
lists with repetitive orders and medications, and other shortcuts in our
EMR to reduce the number of clicks required for common tasks. We also
have a team of “specialists” dedicated to meet with physicians onsite at
their clinics to help optimize individual EMR workflows and
preferences.<br />
<br />
EMR vendors have not been able to place the focus needed on improving
the user interface, largely due to the burdens of meeting ever-growing
regulatory demands for national programs such as Meaningful Use and
MACRA (Medicare Access and CHIP Reauthorization Act). However, the
software’s interface with physicians should be improved, and ARC is
committed to doing all it can.<br />
<br />
<strong>Another way to lighten physicians’ clerical loads: scribes</strong>
who can join physicians during patient visits and assist with EMR
documentation, ordering and other electronic clerical tasks in real
time. ARC had a successful pilot program and is currently offering
scribes to additional physicians who may be interested. We also have
advanced practice clinicians, acting as “extenders” to physicians,
performing and documenting routine exams such as Medicare wellness
check-ups.<br />
<br />
Meanwhile, savvy professionals in many fields are turning to <strong>mindfulness, meditation and other “me time” </strong>activities
to reduce stress. They also can and should turn to each other on this
issue, viewing it as a mentoring topic. A very effective antidote for
decreased resiliency is the professional, day-to-day interaction between
physicians, like discussing diagnostic and treatment challenges or the
joys of those successes. Time challenges have led to fewer of those
interactions. ARC is working on some upcoming formal programs to provide
physicians with some of these stress-reducing tools.<br />
<br />
Healthcare systems and medical groups should partner with physicians
to enhance their resiliency. They have an obligation to do what makes
sense to keep physicians enthused and performing at the highest level.
The best place to start? Allow physicians to do more of what they do
best – heal patients – and less of what others can do – computerized
paperwork and administrative tasks.<br />
<br />
<em>Manish Naik, MD, is a practicing internist at Austin Regional
Clinic (ARC) as well as ARC’s Assistant Chief of Internal Medicine, ARC
Chief Medical Information Officer, and ARC’s Electronic Medical Records
(EMR) Physician Champion. </em><div class="blogger-post-footer">http://feeds.feedburner.com/bloggedarteries</div>Me and My Doctorhttp://www.blogger.com/profile/14771175740273059876noreply@blogger.com0tag:blogger.com,1999:blog-13146143.post-43268633131965275852017-07-31T13:28:00.002-05:002017-07-31T13:28:51.565-05:00The Missing Link: Patient Responsibility for Health Records<i><b>By Joseph H. Schneider, MD, MBA</b></i><br />
<i><b>Department of Pediatrics, University of Texas Southwestern</b></i><br />
<br />
<i>This article was originally published at </i><a href="http://meetings.hayesmanagement.com/blog/the-missing-link-patient-responsibility-for-health-records?utm_source=hs_email&utm_medium=email&utm_content=54643478&_hsenc=p2ANqtz-8Dp7O6dOj0Ibp6mYY_UJ-KN_1mv_xf8E9Y1GOoJJJZt8Y5yH2QNh4lMVG-b-3sbj_qi4TPm6Qggtzwe6aOnm40tzPkkw&_hsmi=54643478" target="_blank">Hayes Management Consulting</a><i>.</i><br />
<span class="hs_cos_wrapper hs_cos_wrapper_meta_field hs_cos_wrapper_type_rich_text" data-hs-cos-general-type="meta_field" data-hs-cos-type="rich_text" id="hs_cos_wrapper_post_body"></span><br />
Sitting on the exam table before a routine procedure, I listened as the nurse reviewed my medical information. She checked my name, address, and birthday. All was well until she said <i>“..and you are allergic to Wellbutrin, Toradol, Darvon and sulfa”</i>. My brain sprang to attention as she continued reading that I had shoulder repair and coronary bypass procedures, that my weight was down 50 kilograms and that my father was alive. It was very detailed.<br />
<br />
It was also all very wrong. I have no medication allergies, nor have I had any of the named surgeries. My weight hasn’t changed. And my father passed away in the 1980s.<br />
<br />
What happened? My record was mixed up with someone else’s and my health care information was now seriously incorrect. Fortunately, as a CMIO, I was able to get the 120 pages of my record rapidly corrected.<br />
<br />
But what if I was an average person, without the influence to gain quick access and to make corrections? What if I hadn’t been having the procedure? The incorrect data could have led to dangerous consequences.<br />
<br />
<div>
Unfortunately, that is the reality for a significant number of individuals today. Patients are misidentified 10 percent of the time, resulting in an inappropriate record merger or a duplicate record. Nine percent of these misidentifications result in medical errors. That’s about one percent of all interactions resulting in errors. According to one study, a significant number of patients are harmed or die each year from identity errors.<a href="http://meetings.hayesmanagement.com/blog/the-missing-link-patient-responsibility-for-health-records?utm_source=hs_email&utm_medium=email&utm_content=54643478&_hsenc=p2ANqtz-8Dp7O6dOj0Ibp6mYY_UJ-KN_1mv_xf8E9Y1GOoJJJZt8Y5yH2QNh4lMVG-b-3sbj_qi4TPm6Qggtzwe6aOnm40tzPkkw&_hsmi=54643478#_ftn1" name="_ftnref1">[1]</a><br />
<br />
I used to believe that patient records were best managed by healthcare organizations and physician offices. But after over 20 years in healthcare informatics, my view has changed. Because patients travel, relocate, transition from a pediatrician, get care in multiple locations, change physicians because of insurance, and many other things, I’ve concluded that it is unrealistic to expect that these multiple medical organizations can get the records of <i>all </i>patients correct <i>all</i> of the time. Even with a national patient identifier, this wouldn’t be possible. And if we can’t achieve extremely high reliability in the accuracy of our records, then a different solution is needed.<br />
<br />
The different solution? Create a system that supports the right and the ability of individuals to be responsible for their own healthcare record and even to have control over it, with help as needed. With respect to interoperability, this means that some patients may even control what information is exchanged because they control their own records. This would augment, not replace, traditional physician/hospital controlled records for those patients who could not handle these responsibilities. The personal involvement that this engenders might be the most important step in getting accurate health information to the right place at the right time.<br />
<br />
<b><i>Getting to where patients can manage and control their records</i></b><br />
<br />
Creating a system that supports patient-controlled health records seems challenging. Here are three things that we could be doing now to get started:<br />
<br />
<b><i>Step 1. Let’s encourage verification of healthcare data by patients</i></b><br />
<br />
When visiting a doctor or healthcare institution, we should encourage patients to view their record, not just have it read to them. If there are errors, let’s correct them on the spot, wherever possible. Where there is disagreement (e.g., “I’m allergic” vs. “That’s not an allergy”), let’s either resolve this or record it so it is visible when the record is viewed in the future, including if the record is shared for care elsewhere.<br />
<br />
If there is something that can’t be done in the visit, (e.g., the extensive errors in my case), let’s make it easy for everyone to get their records corrected. Too often, the request to review records takes an eternity and the records are delivered in a way that makes it near-impossible to find and correct errors.<br />
<br />
Open Notes and some types of patient portals are a start towards this, but patients need encouragement. For those who need help in this (e.g., my 93-year-old mother who recently received a drug to which she was allergic), let’s find ways to provide that help. An example would be extending the role of care coordinators to give them the responsibility of assisting patients with their record review.<br />
<br />
<b><i>Step 2. Let’s develop the tools to enable patient-managed records</i></b><br />
<br />
Patients with complex problems or their caregivers may track their medical data using a word processor, spreadsheet or a commercial personal health record. They often bring this to hospitals and physician offices, but usually there is no easy way to upload this information into the clinician’s EMR. On discharge or the end of their visit, these records are rarely updated automatically. These patients need better easy-to-use tools that our EMRs can use to easily upload and download data.<br />
<br />
Let’s start by asking EMR vendors to incorporate the Blue Button. EMRs that offer the Blue Button use this for downloading health records to patients. They can then share them with other doctors and caregivers, check to make sure the information is accurate and complete, have medical information available in an emergency or plug the information into mobile apps and tools. The Veterans Administration is one of the first organizations to adopt the Blue Button. Let’s work to have all systems adopt this.<br />
<br />
But not every patient wants to maintain their own records. For those who want to use a patient portal, they often are faced with having a portal for every place where they received care. This is absolutely NOT patient-centered. Let’s request our EMR vendors to open their EMR patient portals so that a patient can designate a “master” portal for health information that other systems would feed data to and use as a source for accurate patient information.<br />
<br />
Let’s also request notifications to patients from EMRs any time that their records are changed. Many organizations now send us confirmations of activity electronically. Why can’t this be a basic requirement for healthcare records?<br />
<br />
Developing tools for patient-managed records raises lots of questions such as how to deal with individuals who can’t handle their own records, how to ensure accurate or necessary information isn’t suppressed, and handling patients who incorrectly represent their history. All of these have answers, but we need true national standards or we will recreate the electronic silos of Meaningful Use. So let’s work together as patients, clinical and informatics professionals to plan how this new electronic ecosystem should work. Let’s also build in research capabilities for usability and safety in addition to clinical studies<a href="http://meetings.hayesmanagement.com/blog/the-missing-link-patient-responsibility-for-health-records?utm_source=hs_email&utm_medium=email&utm_content=54643478&_hsenc=p2ANqtz-8Dp7O6dOj0Ibp6mYY_UJ-KN_1mv_xf8E9Y1GOoJJJZt8Y5yH2QNh4lMVG-b-3sbj_qi4TPm6Qggtzwe6aOnm40tzPkkw&_hsmi=54643478#_ftn2" name="_ftnref2">[2]</a> so that every patient’s daily interactions with these tools contributes to our knowledge, with their consent.<br />
<br />
<b><i>Step 3. Let’s educate everyone on the importance of patient-managed records</i></b><br />
<br />
Everyone – patients, doctors, nurses, organizations – needs education that patients have a vested interest in the accuracy of their own health records and, with some education and the right tools, can be qualified to manage them. We need to increase the awareness of the importance of patient involvement.<br />
<br />
The move toward consumerism in healthcare has already started getting patients to take more responsibility for the financial aspects of their care. Let’s encourage the same mindset when it comes to medical records.<br />
<br />
We can begin by working with medical and nursing societies and patient/consumer organizations to convince clinicians and healthcare leaders that patients actually can be responsible for managing their own records.<br />
<br />
<b><i>The process has begun</i></b><br />
<br />
Although implementation of patient maintained records may seem like a distant concept, it is not as far-fetched as it might appear.<br />
<br />
In the UK, a personal health record company called Patients Know Best (PKB) provides patients with secure online access to manage their personal medical records. PKB is integrated into the UK’s National Health Service<a href="http://meetings.hayesmanagement.com/blog/the-missing-link-patient-responsibility-for-health-records?utm_source=hs_email&utm_medium=email&utm_content=54643478&_hsenc=p2ANqtz-8Dp7O6dOj0Ibp6mYY_UJ-KN_1mv_xf8E9Y1GOoJJJZt8Y5yH2QNh4lMVG-b-3sbj_qi4TPm6Qggtzwe6aOnm40tzPkkw&_hsmi=54643478#_ftn3" name="_ftnref3">[3]</a>.<br />
<br />
Here in the U. S., there are numerous personal health records efforts. Few, if any, are in widespread use, in part due to the challenges of maintaining them. Individual health systems such as Scripps Research Institute<a href="http://meetings.hayesmanagement.com/blog/the-missing-link-patient-responsibility-for-health-records?utm_source=hs_email&utm_medium=email&utm_content=54643478&_hsenc=p2ANqtz-8Dp7O6dOj0Ibp6mYY_UJ-KN_1mv_xf8E9Y1GOoJJJZt8Y5yH2QNh4lMVG-b-3sbj_qi4TPm6Qggtzwe6aOnm40tzPkkw&_hsmi=54643478#_ftn4" name="_ftnref4">[4]</a> are working on changing this.<br />
<br />
<b><i>Summary</i></b><br />
<br />
We have spent over $30 billion on making our healthcare system electronic, but have little in place for patients who want to take care of their own records. It’s time we focused on closing this missing link.<br />
<br />
<i>Dr. Schneider is a retired informatician but still practices newborn medicine in Dallas. He can be reached at drjoes1tx@gmail.com.</i><br />
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<span class="hs_cos_wrapper hs_cos_wrapper_meta_field hs_cos_wrapper_type_rich_text" data-hs-cos-general-type="meta_field" data-hs-cos-type="rich_text" id="hs_cos_wrapper_post_body"></span><br />
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<span class="hs_cos_wrapper hs_cos_wrapper_meta_field hs_cos_wrapper_type_rich_text" data-hs-cos-general-type="meta_field" data-hs-cos-type="rich_text" id="hs_cos_wrapper_post_body"><span class="hs-cta-wrapper" id="hs-cta-wrapper-db71672f-f87a-46f0-8707-a615b14716bc"></span></span></div>
<span class="hs_cos_wrapper hs_cos_wrapper_meta_field hs_cos_wrapper_type_rich_text" data-hs-cos-general-type="meta_field" data-hs-cos-type="rich_text" id="hs_cos_wrapper_post_body"><a href="http://meetings.hayesmanagement.com/blog/the-missing-link-patient-responsibility-for-health-records?utm_source=hs_email&utm_medium=email&utm_content=54643478&_hsenc=p2ANqtz-8Dp7O6dOj0Ibp6mYY_UJ-KN_1mv_xf8E9Y1GOoJJJZt8Y5yH2QNh4lMVG-b-3sbj_qi4TPm6Qggtzwe6aOnm40tzPkkw&_hsmi=54643478#_ftnref1" name="_ftn1">[1]</a> <a href="http://perspectives.ahima.org/why-patient-matching-is-a-challenge-research-on-master-patient-index-mpi-data-discrepancies-in-key-identifying-fields/"><i>Why Patient Matching Is a Challenge: Research on Master Patient Index (MPI) Data Discrepancies in Key Identifying Fields</i></a>; Just B et al. Perspectives in Health Information Management, AHIMA Foundation, Spring 2016.<br />
<a href="http://meetings.hayesmanagement.com/blog/the-missing-link-patient-responsibility-for-health-records?utm_source=hs_email&utm_medium=email&utm_content=54643478&_hsenc=p2ANqtz-8Dp7O6dOj0Ibp6mYY_UJ-KN_1mv_xf8E9Y1GOoJJJZt8Y5yH2QNh4lMVG-b-3sbj_qi4TPm6Qggtzwe6aOnm40tzPkkw&_hsmi=54643478#_ftnref2" name="_ftn2">[2]</a> <a href="https://www.wsj.com/articles/smartphones-open-a-new-world-for-medical-researchers-1498442821">https://www.wsj.com/articles/smartphones-open-a-new-world-for-medical-researchers-1498442821</a>; Wallace C. Wall Street Journal, June 25, 2017.<br />
<a href="http://meetings.hayesmanagement.com/blog/the-missing-link-patient-responsibility-for-health-records?utm_source=hs_email&utm_medium=email&utm_content=54643478&_hsenc=p2ANqtz-8Dp7O6dOj0Ibp6mYY_UJ-KN_1mv_xf8E9Y1GOoJJJZt8Y5yH2QNh4lMVG-b-3sbj_qi4TPm6Qggtzwe6aOnm40tzPkkw&_hsmi=54643478#_ftnref3" name="_ftn3">[3]</a> <a href="https://medium.com/change-maker/patients-know-best-a-changemaker-health-case-study-2f203b0971ae"><i>Patients Know Best: A Changemaker Health Case Study</i></a>; Strickland M. March 21, 2017.<br />
<a href="http://meetings.hayesmanagement.com/blog/the-missing-link-patient-responsibility-for-health-records?utm_source=hs_email&utm_medium=email&utm_content=54643478&_hsenc=p2ANqtz-8Dp7O6dOj0Ibp6mYY_UJ-KN_1mv_xf8E9Y1GOoJJJZt8Y5yH2QNh4lMVG-b-3sbj_qi4TPm6Qggtzwe6aOnm40tzPkkw&_hsmi=54643478#_ftnref4" name="_ftn4">[4]</a> <a href="https://www.wsj.com/articles/the-smart-medicine-solution-to-the-health-care-crisis-1499443449">The Smart-Medicine Solution to the Health-Care Crisis</a>; Topol E. Wall Street Journal (subscription required), July 7, 2017</span><br />
<br />
For more information on electronic health records, download the Hayes Management Consulting roadmap, <a href="http://www.hayesmanagement.com/roadmap-how-to-save-your-ehr/">How to Save Your EHR: 6 Steps to Holistic Optimization.</a><br />
<div style="text-align: center;">
<img alt="Hayes_ROADMAP_Save_EHR_Holistic_Optimization_TN_2.jpg" src="http://meetings.hayesmanagement.com/hs-fs/hubfs/images/Hayes_ROADMAP_Save_EHR_Holistic_Optimization_TN_2.jpg?t=1501522766988&width=150&height=116&name=Hayes_ROADMAP_Save_EHR_Holistic_Optimization_TN_2.jpg" height="116" width="150" /></div>
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<div class="blogger-post-footer">http://feeds.feedburner.com/bloggedarteries</div>Me and My Doctorhttp://www.blogger.com/profile/14771175740273059876noreply@blogger.com0tag:blogger.com,1999:blog-13146143.post-23914904340366481552017-06-11T17:40:00.000-05:002017-06-11T17:40:40.841-05:00Texans on the Dias<P>(CHICAGO) As usual at meetings of the American Medical Association House of Delegates, Texans from the youngest to the most experience are playing a lead role in the 2017 summer meeting.</p>
<p>
Former TMA President Sue Bailey, MD, of Fort Worth was reelected to her third term as speaker of the house. Pediatrician Gary Floyd, MD, a member of the TMA Board of Trustees, is completing a two-year stint on the Reference Committee on AMA Finance and Governance. Ray Callas, MD, an anesthesiologist from Beaumont, is serving on the Reference Committee on Legislation; and Jerome Jeevarajan, a student at the University of Texas Southwestern Medical School in Dallas, served on the Reference Committee on Medical Education.</p>
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://1.bp.blogspot.com/-JJpUOSU-Qxg/WT3GHaKXxwI/AAAAAAAAKuU/xFX8uPOwGE45SgzH1xAcy0P2gUdN6TsiQCLcB/s1600/IMG_0125.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="1200" data-original-width="1600" height="240" src="https://1.bp.blogspot.com/-JJpUOSU-Qxg/WT3GHaKXxwI/AAAAAAAAKuU/xFX8uPOwGE45SgzH1xAcy0P2gUdN6TsiQCLcB/s320/IMG_0125.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Clockwise from top left: Dr. Floyd, Dr. Bailey<br />Mr. Jeevarajan, and Dr. Callas</td></tr>
</tbody></table>
<P>The Texas Delegation to the AMA is working hard to ensure a victory on Tuesday, when John Carlo, MD, of Dallas faces off against three other candidates for two seats on the AMA Council on Science and Public Health.</p>
<p>Some other election results already have come in. 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. Mr. Jeevarajan was elected medical student delegate to the AMA House of Delegates, and these Texas students were elected to AMA Medical Student Section Region 3 leadership positions:</p>
<P>
<ul>
<li>Emily Dewar, chair, UT Houston McGovern School of Medicine;</li>
<li>Aaron Wolbrueck, secretary, Texas College of Osteopathic Medicine; and</li>
<li>Jason Meschin, community service chair, Texas A&M College of Medicine.</li></ul>
</p>
<div class="blogger-post-footer">http://feeds.feedburner.com/bloggedarteries</div>Steve Levinehttp://www.blogger.com/profile/05032341081521706316noreply@blogger.com0tag:blogger.com,1999:blog-13146143.post-69592712250686001252017-06-11T10:39:00.000-05:002017-06-11T10:41:23.382-05:00Video: Legislative Session Victories Snapshot<p>Watch this <a href="http://txma.informz.net/z/cjUucD9taT02MTgzMzc3JnA9MSZ1PTc3NjgwNjIzNCZsaT00Mzc0ODYyOQ/index.html" target="_blank">TMA Legislative News Hotline video</a> summary of a few of the biggest issues addressed in the regular session of the 85th Texas Legislature, which concluded a bit more than a week ago. TMA advocacy team members Dan Finch, Troy Alexander, Michelle Romero, and Clayton Stewart share notes on some top legislative priorities lawmakers answered this session: A surprise-billing solution; new law to define and regulate telemedicine; a prevention initiative passed to keep Texans safe; and how Medicaid funding for the next two years could affect patients and physicians. We also add an update on a priority bill signed this week, and shine a light on the future, when lawmakers will return to Austin. All of that, and a special message from TMA’s Advocacy Vice President Darren Whitehurst, are featured in <a href="http://txma.informz.net/z/cjUucD9taT02MTgzMzc3JnA9MSZ1PTc3NjgwNjIzNCZsaT00Mzc0ODYyOQ/index.html" target="_blank">this week’s episode</a>.</p>
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<p>
Tune in next week, when Hotline will delve deeper into issues passed this session, beginning with the budget, mental health, and women’s health — as well as legislation regulating use of maintenance of certification.</p><div class="blogger-post-footer">http://feeds.feedburner.com/bloggedarteries</div>Steve Levinehttp://www.blogger.com/profile/05032341081521706316noreply@blogger.com0tag:blogger.com,1999:blog-13146143.post-35354567892024296712017-05-23T10:36:00.000-05:002017-05-23T11:42:45.358-05:00MOC - It's All About the $$ - Yes to SB 1148<div style="text-align: center;">
<h3><b>Oppose Vendor Greed That Isn’t Shown <br />to Improve Quality</b></h3></div>
<p>Senate Bill 1148, scheduled for debate on the floor of the Texas House of Representatives today, clearly states that hospitals and health plans cannot use maintenance of certification (MOC) to differentiate among physicians for payment, contracting, or credentialing. The bill prohibits the state from using MOC as a requirement for state licensure or renewal. It would, however, allow MOC requirements if facilities or teaching faculty need them for specialty designation or accreditation.</p>
<p>The bill's author is Sen. Dawn Buckingham, MD (R-Lakeway). As a practicing opthalmologist, Senator Buckingham knows a thing or two about the bureaucratic hassles that get in the way of physicians taking care of their patients.</p>
<p>SB 1148 stops the discrimination against physicians who elect to skip the burdensome, often-irrelevant, monopolistic MOC process. MOC claims to ensure quality, but in reality the components tested often are not applicable to medical practices. It’s a revenue generator for testing companies. So if you are wondering why the certifying boards are fighting so hard against SB 1148, remember, it’s all about the money.</p>
<p>"It's a money-making operation," says Texas Medical Association President Carlos J. Cardenas, MD.</p>
<p>In 2014, MOC generated $27 million for the American Board of Internal Medicine (ABIM) (48 percent of total certification testing revenue, 44 percent of total revenue). And, until the backlash really started to hit in 2015, MOC fees have been a steadily rising source of income for ABIM.</p>
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<p>And this is personal for the organization. ABIM’s reported staff expenses (salaries, benefits, and other) increased 53 percent from 2009 to 2016, to $34.1 million. In 2015, ABIM spent $30 million on salaries and benefits and only $6.3 million on actually administering MOC.</p>
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<p>As of 2016, the ABIM’s staff retirement plan net assets were $27.1 million, double the organization’s $13.6 million total net assets.</p>
<p>Mandatory MOC amounts to unnecessary overregulation of medicine. There is no proof at all that MOC improves patient care. Two peer-reviewed studies published in the <a href="http://jamanetwork.com/journals/jama/issue/312/22" target="_blank">Dec. 20, 2014, issue of the <i>Journal of the American Medical Association</i></a> compared physicians who had and had not completed MOC. Those studies found no differences in patient outcomes or in the number of hospitalizations that could have been prevented due to better quality of outpatient care.</p>
<p>Almost all other published studies evaluate initial board certification, not recertification or MOC, and the rigorous requirements for initial certification should not be equated with the busywork required for MOC every two years.</p>
<p>SB 1148 does NOT eliminate the state’s strict standards for physicians to earn continuing medical education credits to maintain our licenses. It does NOT change the status of, negate, or in any way minimize the initial board certification that physicians work so hard to achieve.</p>
<p>And if you haven't done it yet, please use the <a href="https://cqrcengage.com/tma1/app/write-a-letter?0&engagementId=351473" target="_blank">TMA Grassroots Action Center</a> to ask your state representative to vote “YES” on SB 1148</p><div class="blogger-post-footer">http://feeds.feedburner.com/bloggedarteries</div>Steve Levinehttp://www.blogger.com/profile/05032341081521706316noreply@blogger.com01100 Congress Ave, Austin, TX 78701, USA30.2746652 -97.7403504999999774.752630700000001 -139.04894449999998 55.796699700000005 -56.431756499999977tag:blogger.com,1999:blog-13146143.post-66852344271339087982017-05-11T10:46:00.002-05:002017-05-11T10:46:56.849-05:00Mandating MOC to practice medicine is an appalling overstep of nonexistent authority<a href="https://3.bp.blogspot.com/-Ic3JELzb9rE/WRSHS6yeoAI/AAAAAAAAAkA/JqKCVjKwmh0SvJRQpn_qdXTKm5sHNjIvQCLcB/s1600/Dr%2BCarlos%2BCardenas_Portrait_052017.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="200" src="https://3.bp.blogspot.com/-Ic3JELzb9rE/WRSHS6yeoAI/AAAAAAAAAkA/JqKCVjKwmh0SvJRQpn_qdXTKm5sHNjIvQCLcB/s200/Dr%2BCarlos%2BCardenas_Portrait_052017.jpg" width="133" /></a><i><b>By Carlos J. Cardenas, MD</b></i><br />
<i><b>TMA President</b></i><br />
<i><b><br />
</b></i> <i>This article was originally published at</i> <a href="http://www.kevinmd.com/blog/2017/05/mandating-moc-practice-medicine-appalling-overstep-nonexistent-authority.html" target="_blank">KevinMD.com</a>.<br />
<br />
Maintenance of certification (MOC) for something as significant as the practice of medicine seems like a harmless enough idea. But for physicians across the country who dedicate thousands of hours to study, earn licensure, achieve board certification, and practice medicine, MOC is not only unnecessary but also a resource-consuming mandate that does nothing to improve patient outcomes and quality of care.<br />
<br />
According to the American Board of Medical Specialty’s (ABMS’) own website: “Board certification is a voluntary process, and one that is very different from medical licensure … Board certification demonstrates a physician’s exceptional expertise in a particular specialty and/or subspecialty of medical practice.” In other words, physicians who pursue board certification self-identify as professionals committed to ongoing learning and subject-matter mastery. The vast majority of Texas physicians willingly pursue and obtain their initial certification for just that reason.<br />
<br />
ABMS introduced MOC in the past 20 years, granting a lifetime certification to physicians board certified at the time of its creation. The rationale for the arbitrary “grandfathering” date is murky and ambiguous at best.<br />
<br />
In the past 12 months, several states have passed laws specifically disallowing reliance on MOC for credentialing, payment, and contracting. More are considering legislation this year. Serendipitously, Oklahoma had success with Senate Bill 1148 — the same bill number for legislation courageously authored by Texas State Sen. Dawn Buckingham, MD, a physician in the Austin area. Texas’ SB 1148 prohibits the state from using MOC as a requirement for state licensure or renewal. It prohibits hospitals and insurance companies from relying on MOC for credentialing or contracting. That bill is working its way through the Texas Legislature this week.<br />
<br />
The Medical Credentialing System in 2014 reported revenues of more than $2.5 billion — $1 billion of which is attributed to ABMS entities alone. The American Board of Internal Medicine (ABIM) is the largest of ABMS’ credentialing agencies and is responsible for credentialing one-quarter of all physicians.<br />
<br />
Drilling down further into those numbers is eye-opening. ABIM reports $58 million in revenue for 2015, nearly $27 million of which came from MOC fees. With $30 million spent on salaries and benefits that year and only $6.3 million on actually administering the MOC, one could easily draw the conclusion that the push for MOC is nothing more than self-serving largesse. Well, that and the luxury three-bedroom condominium purchased in downtown Philadelphia in December 2007. The money these boards collect and spend — on expenses like first-class, cross-country airfare for their staff — just adds to physicians’ ire over MOC mandates.<br />
<br />
In fact, some specialty boards have emerged as a direct result of the revenue-generating opportunities MOC offers. Forty-two medical specialty boards now exist to conduct MOC courses. Forty-two. Providing employment for test proctors does nothing to improve patient care and outcomes. “Do no harm” is not just an oath to be sworn by physicians. It is also a standard to which MOC should be held. If it truly is voluntary, as ABMS asserts, stop punishing physicians who elect not to pursue it.<br />
<br />
From the extraordinary dedication physicians demonstrate by initially achieving board certification, to meeting and exceeding continuing medical education requirements, to continuously putting patient care first and foremost, mandating MOC to practice medicine is an appalling overstep of nonexistent authority. Not only that, it is driving experienced, caring physicians from practice.<br />
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Texas physicians are determined to end this over-testing tyranny and ensure Texas remains a “right to care” state.<div class="blogger-post-footer">http://feeds.feedburner.com/bloggedarteries</div>Me and My Doctorhttp://www.blogger.com/profile/14771175740273059876noreply@blogger.com0tag:blogger.com,1999:blog-13146143.post-56915200589582130312017-05-05T09:00:00.000-05:002017-05-05T09:00:21.648-05:00Stop HB 4011: Health Insurance Wolf in Sheep's Clothing<div class="separator" style="clear: both; text-align: center;">
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House Bill 4011 amounts to unnecessary overregulation of the business of medicine, and the Texas House of Representatives should reject it.<br />
<br />
HB 4011 would require physicians to receive from the patient a signed disclosure form with an itemized statement of the amounts to be billed for nonemergency medical services before those services are provided. If a physician does not obtain this signed document, the physician is prohibited from providing information to a consumer reporting agency regarding the patient's outstanding medical debt.<br />
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<a href="https://cqrcengage.com/tma1/app/write-a-letter?7&engagementId=345793">Write</a> or call your state representative now.<br />
<br />
Eight reasons to oppose HB 4011:<br />
<br />
<ol>
<li>The bill would overregulate the business of medicine via a law that is really unneeded. This is an anti-free market piece of legislation. No other business is subject to these requirements.</li>
<li>It removes any accountability for health insurers to pay an out-of-network benefit for the patient, discouraging patient choice of physicians.</li>
<li>HB 4011 sets up an impossible hurdle for many physicians to meet. It could force us into the position of either delaying treatment while we wait for a signed disclosure form or making it less likely that we receive payment for the medical care we provided.</li>
<li>State and federal law already provide the protections this bill is aiming for – and they do it in a much simpler manner.</li>
<li>Current state law contains extensive protections to help prevent unpaid medical bills from hurting consumers’ credit. Those protections were included in Senate Bill 1731, which was passed in 2007 to strike a balance between protecting patients from medical debt and maintaining their personal financial responsibilities.</li>
<li>Among the many consumer protections enacted in the 2007 law, physicians upon request must give a patient an estimate of charges for any health care services or supplies if the patient has no insurance or is receiving services out-of-network. Even more stringent requirements apply to hospital-based physicians.</li>
<li>Federal law, the Fair Credit Reporting Act, prohibits states from passing laws or imposing restrictions “relating to information contained in consumer [credit] reports.”</li>
<li>In the current legislative session, medicine is strongly supporting a package of much better insurance reform measures to make it easier for patients to prevent or challenge “surprise medical bills.”</li>
</ol>
<br />
<div>
<br /></div>
<div class="blogger-post-footer">http://feeds.feedburner.com/bloggedarteries</div>Steve Levinehttp://www.blogger.com/profile/05032341081521706316noreply@blogger.com0tag:blogger.com,1999:blog-13146143.post-73919830998694740852017-04-15T15:41:00.000-05:002017-04-15T15:41:09.648-05:00Mandate? Hardly.<div class="MsoNormal" style="margin: 0in 0in 0pt;">
<span>As in a bad Freddy Krueger movie, rumors of a binding,
incestuous relationship between the </span><a href="http://www.licenseportability.org/assets/pdf/Interstate-Medical-Licensure-Compact-(FINAL).pdf"><span>Interstate
Medical License Compact</span></a><span> and Maintenance of Certification (MOC) just will
not die.</span></div>
<br />
<div class="MsoNormal" style="margin: 0in 0in 0pt;">
<span>Let’s set the record straight.<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0in 0in 0pt;">
<span>The Interstate Medical License Compact is a multistate
agreement that allows physicians to obtain a license in a new state faster and
with fewer hassles. Here are some basic facts to remember:<o:p></o:p></span></div>
<br />
<div class="MsoListParagraphCxSpFirst" style="margin: 0in 0in 0pt 0.5in; mso-list: l1 level1 lfo1; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="mso-bidi-font-family: "Baskerville Old Face"; mso-fareast-font-family: "Baskerville Old Face";"><span style="mso-list: Ignore;"><span>1.</span><span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span>The Compact does not replace, override, or
reduce the need for the physician to meet the licensing requirements of the new
state.<o:p></o:p></span></div>
<br />
<div class="MsoListParagraphCxSpMiddle" style="margin: 0in 0in 0pt 0.5in; mso-list: l1 level1 lfo1; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="mso-bidi-font-family: "Baskerville Old Face"; mso-fareast-font-family: "Baskerville Old Face";"><span style="mso-list: Ignore;"><span>2.</span><span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span>Physicians who, for any reason, do not want to
use the Compact still may apply for a license in the new state using the
traditional route.<o:p></o:p></span></div>
<br />
<div class="MsoListParagraphCxSpLast" style="margin: 0in 0in 0pt 0.5in; mso-list: l1 level1 lfo1; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="mso-bidi-font-family: "Baskerville Old Face"; mso-fareast-font-family: "Baskerville Old Face";"><span style="mso-list: Ignore;"><span>3.</span><span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span>Physicians who want to use the Compact must have
an active board certification at the time of the license application through
the compact. The Compact does not require MOC before, during, or after that
procedure.<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0in 0in 0pt;">
<span>Mandate? Hardly.<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0in 0in 0pt;">
<span>Now, as to the position of the Texas Medical Association
(TMA):<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0in 0in 0pt;">
<span>TMA opposes mandatory MOC requirements for licensing,
credentialing, hospital privileges, health plan contracts, or payment. This
position was adopted by votes of the TMA House of Delegates in 2013 and in 2016
in adopting these policies:<o:p></o:p></span></div>
<br />
<div class="MsoListParagraphCxSpFirst" style="margin: 0in 0in 0pt 0.5in; mso-list: l0 level1 lfo2; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span><u>Maintenance of Certification Requirement</u>:
TMA supports the American Medical Association’s Principles of Maintenance of
Certification (MOC) H-275.924 to ensure physician’s choice of lifelong learning,
and will pursue legislation that eliminates discrimination by the State of
Texas, employers, hospitals, and payers based on the American Board of Medical
Specialties’ proprietary MOC program as a requirement for licensure,
employment, hospital staff membership, and payments for medical care in Texas.
(2016)<o:p></o:p></span></div>
<br />
<div class="MsoListParagraphCxSpLast" style="margin: 0in 0in 0pt 0.5in; mso-list: l0 level1 lfo2; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span><u>Opposition to Maintenance of Licensure</u>: TMA
opposes any efforts by the Texas Medical Board (1) that require the Federation
of State Medical Boards’ Maintenance of Licensure (MOL) program as a condition
of licensure, and (2) that unilaterally implement different Maintenance of
Licensure requirements other than those currently in place for physicians in
Texas. (2013)<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0in 0in 0pt;">
<span>In the current (2017) session of the Texas Legislature, TMA
is strongly supporting </span><a href="http://www.capitol.state.tx.us/BillLookup/History.aspx?LegSess=85R&Bill=SB1148"><span>Senate
Bill 1148</span></a><span> by Sen. Dawn Buckingham, MD (R- Lake Travis). That would prohibit
the sole use of MOC status to credential, license, or pay physicians. Kim Monday,
MD, a neurologist from Houston and former president of the Harris County
Medical Society </span><a href="https://www.texmed.org/Template.aspx?id=44616"><span>testified</span></a><span>
for the bill in committee on behalf of TMA. Dr. Monday called the requirement
“burdensome, expensive, and filled with irrelevant curriculum.” She noted the
combined cost including materials, fees, and time away from patients and the
medical practice to undergo the process can be as high as $10,000. Dr. Monday
referred to MOC as a “moneymaking scheme” with “little applicability to
day-to-day practice.”<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0in 0in 0pt;">
<span>The Interstate Medical License Compact provides a route for
Texas to recruit and quickly deploy physicians currently licensed in other
states. Given the desirability of practicing medicine in Texas and the state’s
severe physician shortage, adopting the Compact by the Texas Legislature would
have a positive outcome.<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="margin: 0in 0in 0pt;">
<span>In 2015, the TMA House of Delegates considered but did not
adopt a resolution calling on the association to “oppose the Federation of
State Medical Board’s (FSMB) Interstate Medical Licensure Compact as currently
written.”<o:p></o:p></span></div>
<div class="blogger-post-footer">http://feeds.feedburner.com/bloggedarteries</div>Steve Levinehttp://www.blogger.com/profile/05032341081521706316noreply@blogger.com4tag:blogger.com,1999:blog-13146143.post-71663075127328365532017-04-06T16:15:00.002-05:002017-04-07T08:16:36.227-05:00Speak Up and Be Heard<div class="separator" style="clear: both; text-align: center;">
<a href="https://2.bp.blogspot.com/-hObqeKJfmNU/WOau02kDeaI/AAAAAAAAAjg/-z6LGcgmWi8xv7TJ6Li2mLxDCJtcTdCNwCEw/s1600/32211506134_0b92abfe99_o.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="266" src="https://2.bp.blogspot.com/-hObqeKJfmNU/WOau02kDeaI/AAAAAAAAAjg/-z6LGcgmWi8xv7TJ6Li2mLxDCJtcTdCNwCEw/s400/32211506134_0b92abfe99_o.jpg" width="400" /></a></div>
<i><b>By Sara G. Austin, MD</b></i><br />
<i><b>2017 Travis County Medical Society President</b></i><br />
<br />
<i>This article was originally published in the March/April edition of the </i><a href="http://www.tcms.com/uploadedFiles/Travis_County_Medical_Society/Communications/Journal/2017-March-April-web.pdf" target="_blank">Travis County Medical Society Journal</a>.<i><b><br />
</b></i><br />
Gosh, it's time to write this article again! So I was thinking—no worries, I'll just wait until after the first <a href="https://www.texmed.org/FirstTuesdays" target="_blank">First Tuesday</a> at the Capitol and write about what the House of Medicine is advocating for in this legislative session. There, done, simple. I’ve done that lots of times; it takes about 10 minutes and it's important stuff, stuff you guys need to know something about. Plus the rattlesnake wranglers were at the Capitol and they are fun to watch and make a great picture, and I could talk about that too.<br />
<br />
But this First Tuesday seemed different to me. For one, I work at Seton now, and I'm staffing Brackenridge this week. I saw a nice lady with Medicaid (who couldn't have afforded to see me in my private practice) complaining of hand numbness and weakness. Initially I thought it was just carpal tunnel. But after an exam and some testing, it turned out to be ALS. It made me grateful that I was in a place where I can see people who don't always have good insurance. And staffing Brackenridge makes me aware of how much need is out there. So I go down to First Tuesdays and we are fighting some of the same battles we’ve fought for years and we need to continue to fight—fair policies from insurance companies, patient safety and scope of practice, public health (smoking in public places, vaccinations) and funding for Graduate Medical Education. Medicaid is always mentioned but feels like such a losing battle that sometimes it only gets one sentence, like "Please do something with Medicaid."<br />
<br />
The Capitol was packed on this First Tuesday! I mean it was difficult to walk through the rotunda and up and down the stairs because the sanctuary cities issue was being debated in both chambers. There was a palpable tension in the Capitol that I've not run across before. I hear the same tension in the news when they are talking about D.C.—people trying to figure out how to get their head around this new administration and wondering what's going on, and perhaps, what's going to change?<br />
<br />
I found myself thinking how much easier things were to handle when it was the same old, same old. This conflict, this possibility of doing things differently, this . . . change . . . is now making me nervous. I realize change does that because it brings up the chance of loss, but it has the chance of gain as well. And really, nowhere is change more important to our lives and wellbeing than in health care.<br />
<br />
I am still hoping that something breaks lose for the better. That it somehow gets easier to see and care for patients than it is now. That we don't let people suffer for lack of access to health care. It needs to change. And yes, we have got to keep pushing for Medicaid to improve.<br />
<br />
I think now is the time to speak up—to be heard—especially for the House of Medicine. When else will we ever have a better chance to actually make a difference for our patients? So work to understand the issues, and tell your stories and your patients' stories. Believe me, there are lots of other folks out there telling theirs. Don't forget that the next First Tuesday is April 4. We had a great turn out this last time and really would love to see even more white coats in the Capitol this next time. Think about it.<br />
<br />
Meanwhile, it is comforting that there are still people out there who can mess with a rattlesnake and not (or very rarely) get bit. They may be in the safest place of all this year.<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://4.bp.blogspot.com/-_4Y_T5WHGeA/WOavNheqvyI/AAAAAAAAAjk/cKvzGtNzIggnjxWqvOWA6O7UwZPF9hbHwCEw/s1600/33751858051_337b97e306_o.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="400" src="https://4.bp.blogspot.com/-_4Y_T5WHGeA/WOavNheqvyI/AAAAAAAAAjk/cKvzGtNzIggnjxWqvOWA6O7UwZPF9hbHwCEw/s400/33751858051_337b97e306_o.jpg" width="266" /></a></div>
<div class="blogger-post-footer">http://feeds.feedburner.com/bloggedarteries</div>Me and My Doctorhttp://www.blogger.com/profile/14771175740273059876noreply@blogger.com0tag:blogger.com,1999:blog-13146143.post-30327470715349515852016-11-14T12:19:00.000-06:002016-11-15T07:40:48.786-06:00Texas Doctors See Post-Election Opportunity to Reshape Health Care<div class="MsoNormal">
<span style="font-family: "arial";">(ORLANDO) -- The 2016 elections brought
physicians an excellent opportunity to rebuild America’s health care systems,
Texas Medical Association officials say.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "arial";">“Everything is on the table
— the Affordable Care Act (ACA), Medicare, and Medicaid,” said David Henkes, MD, chair of the
Texas Delegation to the American Medical Association. “Today, we are crafting
plans to remake the system so it truly serves our physician members and our
patients.”<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://2.bp.blogspot.com/-5177tIE5PiE/WCn-u0phFUI/AAAAAAAAKDw/9Hb00fYROSkJfXeh091KC6N-QppRAEmfQCLcB/s1600/IMG_2862.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="225" src="https://2.bp.blogspot.com/-5177tIE5PiE/WCn-u0phFUI/AAAAAAAAKDw/9Hb00fYROSkJfXeh091KC6N-QppRAEmfQCLcB/s400/IMG_2862.jpg" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Drs. Kridel (l) and Henkes prepare to lead discussion on health care reform<br />
at meeting of Texas Delegation to the AMA.</td></tr>
</tbody></table>
<div class="MsoNormal">
<span style="font-family: "arial";">Fortuitously, the interim
meeting of the AMA House of Delegates brought dozens of TMA leaders together
just four days after the Nov. 8 elections. They laid out key strategic
directions that TMA staff will use to devise a detailed plan.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="EVPGram" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "arial"; font-size: 12.0pt;">“We need one document for all
physicians, all specialties, to take to Congress and the administration and
say, ‘This is what medicine believes in,’ ” Houston facial plastic surgeon Russ
Kridel, MD, a member of the AMA Board of Trustees, said at an hour-long health
care reform conversation among members of the Texas Delegation to the AMA, who
are in Orlando, Fla., for the <a href="https://assets.ama-assn.org/sub/meeting/index.html">interim meeting of
the AMA House of Delegates</a>. “We need to act now, and we need to do those
things that will put us at the table.”<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="EVPGram" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "arial"; font-size: 12.0pt;">“The ACA was a first step, now we
need to take another step,” said former AMA and TMA President Jim Rohack, MD.<o:p></o:p></span></div>
<div class="EVPGram" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="EVPGram" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "arial"; font-size: 12.0pt;">The Texas physicians said they are
looking for an approach that simplifies the health care system for physicians
and patients, reduces the huge regulatory burden on physicians, and reduces the
cost of U.S. health care. <o:p></o:p></span></div>
<div class="EVPGram" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "arial";">“This whole system is just
too complicated for most people to handle,” said Dallas psychiatrist Clifford
Moy, MD.<o:p></o:p></span></div>
<div class="EVPGram" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="EVPGram" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "arial"; font-size: 12.0pt;">Many of the ideas in President-Elect
Donald Trump’s <a href="https://www.greatagain.gov/policy/healthcare.html">“Great
Again” health care platform</a> and the <a href="http://abetterway.speaker.gov/?page=health-care">health care agenda in
House Speaker Paul Ryan’s “Better Way” plan</a> are consistent with TMA policy.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "arial";">TMA actively opposed passage
of the ACA in 2010 but has since adopted an approach to “Keep what’s good, fix
what’s broken, and find what’s missing.” Speaker Ryan echoed that approach
during a Nov. 13 television interview, when he said, “We can fix what is broken
in health care without breaking what is working in health care."<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "arial";">Six years of near absolute
gridlock in Washington, DC, prevented even the tiniest ACA reforms from
passing. One very significant achievement – from TMA’s “Find what’s missing”
category – was the repeal of Medicare’s Sustainable Growth Rate (SGR) formula
via the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "arial";">“Texas Solution” Gets New Life<o:p></o:p></span></b></div>
<div class="MsoNormal">
<br /></div>
<div class="EVPGrampre-bullet" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "arial"; font-size: 12.0pt;">It’s important to remember that what
happens in Washington not only affects Medicare, commercial health insurance,
and coverage for uninsured patients, but also plays a big role in how states
implement the Medicaid program. <o:p></o:p></span></div>
<div class="EVPGrampre-bullet" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="EVPGrampre-bullet" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "arial"; font-size: 12.0pt;">“We are entering into a new time,”
U.S. Rep. Michael Burgess, MD (R-Lewisville), said at a fundraising reception
TMA hosted for him in Orlando. “I would love it if the governors came to
Washington and said, ‘OK, guys, you deliver the mail and secure the border,
we’ll take care of our sick folks.’ That would be a far, far more reasonable
way to approach it.” <o:p></o:p></span></div>
<div class="EVPGrampre-bullet" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://1.bp.blogspot.com/-iCo3ky1tQMY/WCn-uklJr5I/AAAAAAAAKDs/wW2oAdzZJMMS2jG6MmTlDgVfyScFdmyDgCEw/s1600/IMG_2871%2B%25281%2529.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="225" src="https://1.bp.blogspot.com/-iCo3ky1tQMY/WCn-uklJr5I/AAAAAAAAKDs/wW2oAdzZJMMS2jG6MmTlDgVfyScFdmyDgCEw/s400/IMG_2871%2B%25281%2529.jpg" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Representative Burgess (l) discusses opportunities for major health system<br />
changes with Drs. Robert Gunby (c) and John Carlo (r) of Dallas.</td></tr>
</tbody></table>
<div class="EVPGrampre-bullet" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "arial"; font-size: 12.0pt;">Dr. Burgess likely will be a key
player in the health care debate in the next Congress. <o:p></o:p></span></div>
<div class="EVPGrampre-bullet" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<br /></div>
<div class="EVPGrampre-bullet" style="margin-bottom: .0001pt; margin-bottom: 0in;">
<span style="font-family: "arial"; font-size: 12.0pt;">Both the Trump and Ryan plans call
for Medicaid changes that mirror the “Texas Solution” for expanded coverage
that TMA has promoted since 2013. The Texas Solution calls for a comprehensive
plan that: <o:p></o:p></span></div>
<div class="EVPGrambullet" style="margin-bottom: .0001pt; margin-bottom: 0in; mso-list: l0 level1 lfo1;">
</div>
<ul>
<li><span style="font-family: "arial"; font-size: 12pt; text-indent: -0.25in;">Improves
patient care;</span></li>
<li><span style="font-family: "arial"; font-size: 12pt; text-indent: -0.25in;">Draws
down all available federal dollars to expand access to health care for poor
Texans;</span></li>
<li><span style="font-family: "arial"; font-size: 12pt; text-indent: -0.25in;">Gives
Texas the flexibility to change the plan as our needs and circumstances change;</span></li>
<li><span style="font-family: "arial"; font-size: 12pt; text-indent: -0.25in;">Clears
away Medicaid’s financial, administrative, and regulatory hurdles that are
driving up costs and driving Texas physicians away from the program;</span></li>
<li><span style="font-family: "arial"; font-size: 12pt; text-indent: -0.25in;">Relieves
local Texas taxpayers and Texans with insurance from the unfair and unnecessary
burden of paying the entire cost of caring for their uninsured neighbors; and</span></li>
<li><span style="font-family: "arial"; font-size: 12pt; text-indent: -0.25in;">Pays
physicians for Medicaid services at a rate at least equal to Medicare payments.</span></li>
</ul>
<!--[if !supportLists]--><br />
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "arial"; font-size: 12pt;">TMA staff are preparing a
white paper on “Post-Election Strategies for Health System Reform” for
discussion at the </span><a href="https://www.texmed.org/AdvocacyRetreat/" style="font-family: Arial; font-size: 12pt;">TMA
Advocacy Retreat</a><span style="font-family: "arial"; font-size: 12pt;">, Dec. 2-3 in Austin.</span></div>
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</style><div class="blogger-post-footer">http://feeds.feedburner.com/bloggedarteries</div>Steve Levinehttp://www.blogger.com/profile/05032341081521706316noreply@blogger.com0tag:blogger.com,1999:blog-13146143.post-31267673718833993822016-11-09T16:26:00.000-06:002016-11-09T16:31:05.967-06:00TEXPAC and Texas Physicians Enjoy Strong Election Results<span style="font-family: "arial"; font-size: 12pt;">This unique presidential election brought on many predictions and projections for who would win, but even as the polls closed last night, most voters were unsure of the likely outcome and how it would affect the races across the state.</span><br />
<span style="font-family: "arial"; font-size: 12pt;"><br /></span>
<span style="font-family: "arial"; font-size: 12pt;">As expected, voters flocked to the polls to vote for the next president. But while Texas set a record for early voter turnout, our Election Day turnout struggled — most Texans had cast their ballot early. TEXPAC’s concern was that the high volume of voters overall would affect our friends running for reelection in swing districts in counties such as Bexar, Dallas, Harris, and Travis. However, hard work and Donald Trump’s 54-percent win in Texas helped most of our friends claim victory last night.</span><br />
<span style="font-family: "arial"; font-size: 12pt;"><br /></span>
<span style="font-family: "arial"; font-size: 12pt;"><strong>Wins for Medicine</strong></span><br />
<span style="font-family: "arial"; font-size: 12pt;"><br /></span>
<span style="font-family: "arial"; font-size: 12pt;">The election resulted in two HUGE wins for medicine. We have two new TMA/TEXPAC physicians elected to the Texas Legislature! <strong>Sen.-Elect Dawn Buckingham, MD</strong>, won Senate District 24 with 72.4 percent of the vote, and <strong>Rep.-Elect Tom Oliverson, MD</strong>, is the newest physician in the Texas House. He won House District 130 in the primary election last March and ran unopposed in the general election. TEXPAC endorsed both candidates in the primary and general elections, and we are thrilled to work with them in the upcoming legislative session.</span><br />
<span style="font-family: "arial"; font-size: 12pt;"><br /></span>
<span style="font-family: "arial"; font-size: 12pt;">TEXPAC had an extremely successful night. In total, 119 endorsed candidates for the Texas House, 16 for the Texas Senate, and four endorsed judicial candidates were victorious. Despite these successes, we did lose three friendly incumbents to their challengers:</span><br />
<ul>
<li><span style="font-family: "arial"; font-size: 12pt;">In House District 117, Rick Galindo (R) was defeated by former State Rep. Philip Cortez (D). A Democrat usually holds the seat, and we expected this outcome, but we are sad to lose Rick Galindo. Fortunately, Philip Cortez is also a friend of medicine. He was a champion of our issues during the 83rd legislative session, and we are excited to work with him again.</span></li>
<li><span style="font-family: "arial"; font-size: 12pt;">In Harris County, we saw a similar scenario. In House District 144, another swing district, former State Rep. Mary Ann Perez reclaimed her seat from TEXPAC-endorsed Gilbert Pena (R).</span></li>
<li><span style="font-family: "arial"; font-size: 12pt;">The most disappointing loss for medicine last night, however, was in House District 107. Our good friend Kenneth Sheets (R) was defeated by his opponent Victoria Neave (D). This is a big loss for TEXPAC; Kenneth Sheets was a wonderful state representative, as well as a champion for medicine. He had a great relationship with the TMA Advocacy team and even better relations with his local physicians. He played a big role on the House Insurance Committee, and we are sad to lose him. His race was considered to be one of the toughest this cycle, and we worked hard to help him get reelected. I know he is grateful for the support we provided him as an organization.</span></li>
</ul>
<span style="font-family: "arial"; font-size: 12pt;">Fortunately, most of our friends will be back to represent medicine in the 85th legislative session. We are extremely excited for our friendly incumbents to return, and we also are looking forward to working with the new members we supported. Below are the results for our priority races.</span><br />
<span style="color: black; font-family: "arial"; font-size: xx-small;"></span><br />
<table border="0" cellpadding="0" cellspacing="0" style="border-collapse: collapse; width: 100%;">
<colgroup><col style="mso-width-alt: 3803; mso-width-source: userset; width: 78pt;" width="104"></col>
<col style="mso-width-alt: 8045; mso-width-source: userset; width: 165pt;" width="220"></col>
<col style="mso-width-alt: 6802; mso-width-source: userset; width: 140pt;" width="186"></col>
</colgroup><tbody>
<tr height="21" style="height: 15.75pt;">
<td class="xl65" height="21" style="height: 15.75pt; padding-bottom: 0in; padding-top: 0in; width: 78pt;" width="104"><div style="line-height: normal;">
<span style="font-family: "arial" , "helvetica" , sans-serif;"><u>RACE</u></span></div>
</td>
<td class="xl65" style="width: 165pt;" width="220"><div style="line-height: normal;">
<span style="font-family: "arial" , "helvetica" , sans-serif;"><u>WINNER</u></span></div>
</td>
<td class="xl68" style="width: 140pt;" width="186"><div style="line-height: normal;">
<span style="font-family: "arial" , "helvetica" , sans-serif;"><u>PERCENT OF VOTE</u></span></div>
</td>
</tr>
<tr height="20" style="height: 15.0pt;">
<td class="xl67" colspan="3" height="20" style="height: 15.0pt; padding-bottom: 0in; padding-top: 0in; width: 383pt;" width="510"><div style="line-height: normal;">
<span style="font-family: "arial" , "helvetica" , sans-serif;"><i><br />State Senate</i></span></div>
</td>
</tr>
<tr height="21" style="height: 15.75pt;">
<td class="xl66" height="21" style="height: 15.75pt; padding-bottom: 0in; padding-top: 0in; width: 78pt;" width="104"><div style="line-height: normal;">
<span style="font-family: "arial" , "helvetica" , sans-serif;">SD 19 </span></div>
</td>
<td class="xl65" style="width: 165pt;" width="220"><div style="line-height: normal;">
<span style="font-family: "arial" , "helvetica" , sans-serif;">Carlos Uresti
(D) </span></div>
</td>
<td class="xl69" style="width: 140pt;" width="186"><div style="line-height: normal;">
<span style="font-family: "arial" , "helvetica" , sans-serif;">55.80%</span></div>
</td>
</tr>
<tr height="21" style="height: 15.75pt;">
<td class="xl66" height="21" style="height: 15.75pt; padding-bottom: 0in; padding-top: 0in; width: 78pt;" width="104"><div style="line-height: normal;">
<span style="font-family: "arial" , "helvetica" , sans-serif;">SD 20</span></div>
</td>
<td class="xl65" style="width: 165pt;" width="220"><div style="line-height: normal;">
<span style="font-family: "arial" , "helvetica" , sans-serif;">Juan “Chuy” Hinojosa (D)</span></div>
</td>
<td class="xl69" style="width: 140pt;" width="186"><div style="line-height: normal;">
<span style="font-family: "arial" , "helvetica" , sans-serif;">61.70%</span></div>
</td>
</tr>
<tr height="21" style="height: 15.75pt;">
<td class="xl66" height="21" style="height: 15.75pt; padding-bottom: 0in; padding-top: 0in; width: 78pt;" width="104"><div style="line-height: normal;">
<span style="font-family: "arial" , "helvetica" , sans-serif;">SD 24</span></div>
</td>
<td class="xl65" style="width: 165pt;" width="220"><div style="line-height: normal;">
<span style="font-family: "arial" , "helvetica" , sans-serif;">Dawn Buckingham, MD (R)</span></div>
</td>
<td class="xl68" style="width: 140pt;" width="186"><div style="line-height: normal;">
<span style="font-family: "arial" , "helvetica" , sans-serif;">72.4% (new
member)</span></div>
</td>
</tr>
<tr height="20" style="height: 15.0pt;">
<td class="xl67" colspan="3" height="20" style="height: 15.0pt; padding-bottom: 0in; padding-top: 0in; width: 383pt;" width="510"><div style="line-height: normal;">
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /><i>State House</i></span></div>
</td>
</tr>
<tr height="21" style="height: 15.75pt;">
<td class="xl66" height="21" style="height: 15.75pt; padding-bottom: 0in; padding-top: 0in; width: 78pt;" width="104"><div style="line-height: normal;">
<span style="font-family: "arial" , "helvetica" , sans-serif;">HD 23 </span></div>
</td>
<td class="xl65" style="width: 165pt;" width="220"><div style="line-height: normal;">
<span style="font-family: "arial" , "helvetica" , sans-serif;">Wayne Faircloth (R)</span></div>
</td>
<td class="xl69" style="width: 140pt;" width="186"><div style="line-height: normal;">
<span style="font-family: "arial" , "helvetica" , sans-serif;">58.90%</span></div>
</td>
</tr>
<tr height="21" style="height: 15.75pt;">
<td class="xl66" height="21" style="height: 15.75pt; padding-bottom: 0in; padding-top: 0in; width: 78pt;" width="104"><div style="line-height: normal;">
<span style="font-family: "arial" , "helvetica" , sans-serif;">HD 33</span></div>
</td>
<td class="xl65" style="width: 165pt;" width="220"><div style="line-height: normal;">
<span style="font-family: "arial" , "helvetica" , sans-serif;">Justin Holland (R)</span></div>
</td>
<td class="xl68" style="width: 140pt;" width="186"><div style="line-height: normal;">
<span style="font-family: "arial" , "helvetica" , sans-serif;">67.8% (new
member)</span></div>
</td>
</tr>
<tr height="21" style="height: 15.75pt;">
<td class="xl66" height="21" style="height: 15.75pt; padding-bottom: 0in; padding-top: 0in; width: 78pt;" width="104"><div style="line-height: normal;">
<span style="font-family: "arial" , "helvetica" , sans-serif;">HD 41</span></div>
</td>
<td class="xl65" style="width: 165pt;" width="220"><div style="line-height: normal;">
<span style="font-family: "arial" , "helvetica" , sans-serif;">Bobby Guerra (D)</span></div>
</td>
<td class="xl69" style="width: 140pt;" width="186"><div style="line-height: normal;">
<span style="font-family: "arial" , "helvetica" , sans-serif;">56.80%</span></div>
</td>
</tr>
<tr height="21" style="height: 15.75pt;">
<td class="xl66" height="21" style="height: 15.75pt; padding-bottom: 0in; padding-top: 0in; width: 78pt;" width="104"><div style="line-height: normal;">
<span style="font-family: "arial" , "helvetica" , sans-serif;">HD 43</span></div>
</td>
<td class="xl65" style="width: 165pt;" width="220"><div style="line-height: normal;">
<span style="font-family: "arial" , "helvetica" , sans-serif;">J.M. Lozano (R)</span></div>
</td>
<td class="xl69" style="width: 140pt;" width="186"><div style="line-height: normal;">
<span style="font-family: "arial" , "helvetica" , sans-serif;">61.20%</span></div>
</td>
</tr>
<tr height="21" style="height: 15.75pt;">
<td class="xl66" height="21" style="height: 15.75pt; padding-bottom: 0in; padding-top: 0in; width: 78pt;" width="104"><div style="line-height: normal;">
<span style="font-family: "arial" , "helvetica" , sans-serif;">HD 47</span></div>
</td>
<td class="xl65" style="width: 165pt;" width="220"><div style="line-height: normal;">
<span style="font-family: "arial" , "helvetica" , sans-serif;">Paul Workman (R)</span></div>
</td>
<td class="xl69" style="width: 140pt;" width="186"><div style="line-height: normal;">
<span style="font-family: "arial" , "helvetica" , sans-serif;">53.60%</span></div>
</td>
</tr>
<tr height="21" style="height: 15.75pt;">
<td class="xl66" height="21" style="height: 15.75pt; padding-bottom: 0in; padding-top: 0in; width: 78pt;" width="104"><div style="line-height: normal;">
<span style="font-family: "arial" , "helvetica" , sans-serif;">HD 54</span></div>
</td>
<td class="xl65" style="width: 165pt;" width="220"><div style="line-height: normal;">
<span style="font-family: "arial" , "helvetica" , sans-serif;">Scott Cosper (R)</span></div>
</td>
<td class="xl68" style="width: 140pt;" width="186"><div style="line-height: normal;">
<span style="font-family: "arial" , "helvetica" , sans-serif;">54.8% (new
member)</span></div>
</td>
</tr>
<tr height="21" style="height: 15.75pt;">
<td class="xl66" height="21" style="height: 15.75pt; padding-bottom: 0in; padding-top: 0in; width: 78pt;" width="104"><div style="line-height: normal;">
<span style="font-family: "arial" , "helvetica" , sans-serif;">HD 64</span></div>
</td>
<td class="xl65" style="width: 165pt;" width="220"><div style="line-height: normal;">
<span style="font-family: "arial" , "helvetica" , sans-serif;">Lynn Stucky (R)</span></div>
</td>
<td class="xl68" style="width: 140pt;" width="186"><div style="line-height: normal;">
<span style="font-family: "arial" , "helvetica" , sans-serif;">61.6% (new
member)</span></div>
</td>
</tr>
<tr height="21" style="height: 15.75pt;">
<td class="xl66" height="21" style="height: 15.75pt; padding-bottom: 0in; padding-top: 0in; width: 78pt;" width="104"><div style="line-height: normal;">
<span style="font-family: "arial" , "helvetica" , sans-serif;">HD 65</span></div>
</td>
<td class="xl65" style="width: 165pt;" width="220"><div style="line-height: normal;">
<span style="font-family: "arial" , "helvetica" , sans-serif;">Ron Simmons (R)</span></div>
</td>
<td class="xl69" style="width: 140pt;" width="186"><div style="line-height: normal;">
<span style="font-family: "arial" , "helvetica" , sans-serif;">56.30%</span></div>
</td>
</tr>
<tr height="21" style="height: 15.75pt;">
<td class="xl66" height="21" style="height: 15.75pt; padding-bottom: 0in; padding-top: 0in; width: 78pt;" width="104"><div style="line-height: normal;">
<span style="font-family: "arial" , "helvetica" , sans-serif;">HD 102</span></div>
</td>
<td class="xl65" style="width: 165pt;" width="220"><div style="line-height: normal;">
<span style="font-family: "arial" , "helvetica" , sans-serif;">Linda Koop (R)</span></div>
</td>
<td class="xl69" style="width: 140pt;" width="186"><div style="line-height: normal;">
<span style="font-family: "arial" , "helvetica" , sans-serif;">54.70%</span></div>
</td>
</tr>
<tr height="21" style="height: 15.75pt;">
<td class="xl66" height="21" style="height: 15.75pt; padding-bottom: 0in; padding-top: 0in; width: 78pt;" width="104"><div style="line-height: normal;">
<span style="font-family: "arial" , "helvetica" , sans-serif;">HD 105</span></div>
</td>
<td class="xl65" style="width: 165pt;" width="220"><div style="line-height: normal;">
<span style="font-family: "arial" , "helvetica" , sans-serif;">Rodney Anderson (R)</span></div>
</td>
<td class="xl69" style="width: 140pt;" width="186"><div style="line-height: normal;">
<span style="font-family: "arial" , "helvetica" , sans-serif;">50.10%</span></div>
</td>
</tr>
<tr height="21" style="height: 15.75pt;">
<td class="xl66" height="21" style="height: 15.75pt; padding-bottom: 0in; padding-top: 0in; width: 78pt;" width="104"><div style="line-height: normal;">
<span style="font-family: "arial" , "helvetica" , sans-serif;">HD 107</span></div>
</td>
<td class="xl65" style="width: 165pt;" width="220"><div style="line-height: normal;">
<span style="font-family: "arial" , "helvetica" , sans-serif;">Victoria Neave
(D)</span></div>
</td>
<td class="xl68" style="width: 140pt;" width="186"><div style="line-height: normal;">
<span style="font-family: "arial" , "helvetica" , sans-serif;">50.8% (new
member)</span></div>
</td>
</tr>
<tr height="21" style="height: 15.75pt;">
<td class="xl66" height="21" style="height: 15.75pt; padding-bottom: 0in; padding-top: 0in; width: 78pt;" width="104"><div style="line-height: normal;">
<span style="font-family: "arial" , "helvetica" , sans-serif;">HD 112</span></div>
</td>
<td class="xl65" style="width: 165pt;" width="220"><div style="line-height: normal;">
<span style="font-family: "arial" , "helvetica" , sans-serif;">Angie Chen Button (R)</span></div>
</td>
<td class="xl69" style="width: 140pt;" width="186"><div style="line-height: normal;">
<span style="font-family: "arial" , "helvetica" , sans-serif;">57.20%</span></div>
</td>
</tr>
<tr height="21" style="height: 15.75pt;">
<td class="xl66" height="21" style="height: 15.75pt; padding-bottom: 0in; padding-top: 0in; width: 78pt;" width="104"><div style="line-height: normal;">
<span style="font-family: "arial" , "helvetica" , sans-serif;">HD 113</span></div>
</td>
<td class="xl65" style="width: 165pt;" width="220"><div style="line-height: normal;">
<span style="font-family: "arial" , "helvetica" , sans-serif;">Cindy Burkett
(R)</span></div>
</td>
<td class="xl69" style="width: 140pt;" width="186"><div style="line-height: normal;">
<span style="font-family: "arial" , "helvetica" , sans-serif;">55.20%</span></div>
</td>
</tr>
<tr height="21" style="height: 15.75pt;">
<td class="xl66" height="21" style="height: 15.75pt; padding-bottom: 0in; padding-top: 0in; width: 78pt;" width="104"><div style="line-height: normal;">
<span style="font-family: "arial" , "helvetica" , sans-serif;">HD 114</span></div>
</td>
<td class="xl65" style="width: 165pt;" width="220"><div style="line-height: normal;">
<span style="font-family: "arial" , "helvetica" , sans-serif;">Jason Villalba (R)</span></div>
</td>
<td class="xl69" style="width: 140pt;" width="186"><div style="line-height: normal;">
<span style="font-family: "arial" , "helvetica" , sans-serif;">55.70%</span></div>
</td>
</tr>
<tr height="21" style="height: 15.75pt;">
<td class="xl66" height="21" style="height: 15.75pt; padding-bottom: 0in; padding-top: 0in; width: 78pt;" width="104"><div style="line-height: normal;">
<span style="font-family: "arial" , "helvetica" , sans-serif;">HD 117</span></div>
</td>
<td class="xl65" style="width: 165pt;" width="220"><div style="line-height: normal;">
<span style="font-family: "arial" , "helvetica" , sans-serif;">Philip Cortez
(D)</span></div>
</td>
<td class="xl68" style="width: 140pt;" width="186"><div style="line-height: normal;">
<span style="font-family: "arial" , "helvetica" , sans-serif;">51.4% (new
member)</span></div>
</td>
</tr>
<tr height="21" style="height: 15.75pt;">
<td class="xl66" height="21" style="height: 15.75pt; padding-bottom: 0in; padding-top: 0in; width: 78pt;" width="104"><div style="line-height: normal;">
<span style="font-family: "arial" , "helvetica" , sans-serif;">HD 118</span></div>
</td>
<td class="xl65" style="width: 165pt;" width="220"><div style="line-height: normal;">
<span style="font-family: "arial" , "helvetica" , sans-serif;">Tomas Uresti (D)</span></div>
</td>
<td class="xl68" style="width: 140pt;" width="186"><div style="line-height: normal;">
<span style="font-family: "arial" , "helvetica" , sans-serif;">55.2% (new
member)</span></div>
</td>
</tr>
<tr height="21" style="height: 15.75pt;">
<td class="xl66" height="21" style="height: 15.75pt; padding-bottom: 0in; padding-top: 0in; width: 78pt;" width="104"><div style="line-height: normal;">
<span style="font-family: "arial" , "helvetica" , sans-serif;">HD 134</span></div>
</td>
<td class="xl65" style="width: 165pt;" width="220"><div style="line-height: normal;">
<span style="font-family: "arial" , "helvetica" , sans-serif;">Sarah Davis
(R)</span></div>
</td>
<td class="xl69" style="width: 140pt;" width="186"><div style="line-height: normal;">
<span style="font-family: "arial" , "helvetica" , sans-serif;">53.60%</span></div>
</td>
</tr>
<tr height="21" style="height: 15.75pt;">
<td class="xl66" height="21" style="height: 15.75pt; padding-bottom: 0in; padding-top: 0in; width: 78pt;" width="104"><div style="line-height: normal;">
<span style="font-family: "arial" , "helvetica" , sans-serif;">HD 136</span></div>
</td>
<td class="xl65" style="width: 165pt;" width="220"><div style="line-height: normal;">
<span style="font-family: "arial" , "helvetica" , sans-serif;">Tony Dale (R)</span></div>
</td>
<td class="xl70" style="width: 140pt;" width="186"><div style="line-height: normal;">
<span style="font-family: "arial" , "helvetica" , sans-serif;">55%</span></div>
</td>
</tr>
<tr height="21" style="height: 15.75pt;">
<td class="xl66" height="21" style="height: 15.75pt; padding-bottom: 0in; padding-top: 0in; width: 78pt;" width="104"><div style="line-height: normal;">
<span style="font-family: "arial" , "helvetica" , sans-serif;">HD 144</span></div>
</td>
<td class="xl65" style="width: 165pt;" width="220"><div style="line-height: normal;">
<span style="font-family: "arial" , "helvetica" , sans-serif;">Mary Ann Perez (D)</span></div>
</td>
<td class="xl68" style="width: 140pt;" width="186"><div style="line-height: normal;">
<span style="font-family: "arial" , "helvetica" , sans-serif;">60.2% (new
member)</span></div>
</td>
</tr>
<tr height="21" style="height: 15.75pt;">
<td class="xl66" height="21" style="height: 15.75pt; padding-bottom: 0in; padding-top: 0in; width: 78pt;" width="104"><div style="line-height: normal;">
<span style="font-family: "arial" , "helvetica" , sans-serif;">HD 149</span></div>
</td>
<td class="xl65" style="width: 165pt;" width="220"><div style="line-height: normal;">
<span style="font-family: "arial" , "helvetica" , sans-serif;">Hubert Vo (D)</span></div>
</td>
<td class="xl69" style="width: 140pt;" width="186"><div style="line-height: normal;">
<span style="font-family: "arial" , "helvetica" , sans-serif;">63.50%</span></div>
</td>
</tr>
<tr height="20" style="height: 15.0pt;">
<td class="xl67" colspan="3" height="20" style="height: 15.0pt; padding-bottom: 0in; padding-top: 0in; width: 383pt;" width="510"><div style="line-height: normal;">
<span style="font-family: "arial" , "helvetica" , sans-serif;"><br /><i>Texas Supreme Court </i></span></div>
</td>
</tr>
<tr height="21" style="height: 15.75pt;">
<td class="xl66" height="21" style="height: 15.75pt; padding-bottom: 0in; padding-top: 0in; width: 78pt;" width="104"><div style="line-height: normal;">
<span style="font-family: "arial" , "helvetica" , sans-serif;">Place 5</span></div>
</td>
<td class="xl66" style="width: 165pt;" width="220"><div style="line-height: normal;">
<span style="font-family: "arial" , "helvetica" , sans-serif;">Paul
Green (R)</span></div>
</td>
<td class="xl69" style="width: 140pt;" width="186"><div style="line-height: normal;">
<span style="font-family: "arial" , "helvetica" , sans-serif;">54.30%</span></div>
</td>
</tr>
<tr height="21" style="height: 15.75pt;">
<td class="xl66" height="21" style="height: 15.75pt; padding-bottom: 0in; padding-top: 0in; width: 78pt;" width="104"><div style="line-height: normal;">
<span style="font-family: "arial" , "helvetica" , sans-serif;">Place 9</span></div>
</td>
<td class="xl66" style="width: 165pt;" width="220"><div style="line-height: normal;">
<span style="font-family: "arial" , "helvetica" , sans-serif;">Eva Guzman (R)</span></div>
</td>
<td class="xl69" style="width: 140pt;" width="186"><div style="line-height: normal;">
<span style="font-family: "arial" , "helvetica" , sans-serif;">55.80%</span></div>
</td>
</tr>
</tbody></table>
<span style="color: black; font-family: "arial"; font-size: xx-small;">
<table border="0" cellpadding="1" cellspacing="0" style="border-collapse: collapse; width: 100%;">
<tbody>
<tr>
<td align="left" rowspan="2" style="color: #b10043; font-family: "arial" , "helvetica" , sans-serif; font-size: 14pt; padding-right: 15px;" valign="top"></td></tr>
<tr><td align="left" style="color: black; font-family: "arial" , "helvetica" , sans-serif; font-size: 10pt;" valign="top"><br /></td>
</tr>
</tbody>
</table>
</span><br />
<!--end_news(2280455)--><!--begin_news(2280456)--><span style="color: black; font-family: "arial"; font-size: xx-small;"></span><br />
<br />
<span style="color: black; font-family: "arial"; font-size: xx-small;">
<table border="1" cellpadding="3" cellspacing="0" style="width: 100%;">
<tbody>
<tr>
<td><span 8pt="" arial="" font-size:="" sans-serif=""><span style="font-family: "arial";"></span></span><span style="font-family: "arial"; font-size: 8pt;">Texas Medical Association Political Action Committee (TEXPAC) is a bi-partisan political action committee of TMA and affiliated with the American Medical Association Political Action Committee (AMPAC) for congressional contribution purposes only. Its goal is to support and elect pro-medicine candidates on both the federal and state level. Voluntary contributions by individuals to TEXPAC should be written on personal checks. Funds attributed to individuals or professional association (PAs) that would exceed federal contribution limits will be placed in the TEXPAC statewide account to support non-federal political candidates. Contributions are not limited to the suggested amounts. TEXPAC will not favor or disadvantage anyone based on the amounts or failure to make contributions. Contributions used for federal purposes are subject to the prohibitions and limitations of the Federal Election Campaign Act.</span><br />
<span style="font-family: "arial"; font-size: 8pt;">Contributions or gifts to TEXPAC or any CMS PAC are not deductible as charitable contributions or business expenses for Federal income tax purposes.</span><br />
<span style="font-family: "arial"; font-size: 8pt;">Federal law requires us to use our best efforts to collect and report the name, mailing address, occupation, and name of employer of individuals whose contributions exceed $200 in a calendar year. To satisfy this regulation, please include your occupation and employer information in the space provided. Contributions from a practice business account must disclose the name of the practice and the allocation of contributions for each contributing owner. Should you have any questions, please call TEXPAC at (512) 370-1361.</span><br />
<div style="text-align: center;">
<span style="font-family: "arial"; font-size: 8pt;"><em>Paid for by the <a choice="1" href="http://www.texpac.org/?utm_source=Informz&utm_medium=Email&utm_campaign=INFORMZ+TEXPAC+NEWSLETTER+3%2D30%2D15" target="_blank">Texas Medical Association Political Action Committee<!--TRACKCUSTLINKZ--></a></em><em><br /> <em>401 W. 15th St. Austin, TX 78701</em></em></span></div>
</td>
</tr>
</tbody></table>
</span><div class="blogger-post-footer">http://feeds.feedburner.com/bloggedarteries</div>Steve Levinehttp://www.blogger.com/profile/05032341081521706316noreply@blogger.com1tag:blogger.com,1999:blog-13146143.post-7529189667920130092016-10-14T12:38:00.000-05:002016-10-15T11:40:21.517-05:00Ready for MACRA? TMA Can Help<p>Earlier today, the Centers for Medicare & Medicaid Services (CMS) released its <a href="https://qpp.cms.gov/docs/QPP_Executive_Summary_of_Final_Rule.pdf">final rule implementing the Medicare Access and CHIP Reauthorization Act</a> (MACRA). Physician practices across the country now have a busy two and a half months trying to get ready to begin collecting and reporting data on Jan. 1.</p>
<p>TMA will continue to work with CMS and the Texas congressional delegation to rewrite and reform many of the <a href="https://www.texmed.org/uploadedFiles/Current/2016_Practice_Help/Clinical_Quality_and_Payment/MACRA/MACRA_position_statement_July2016.pdf">problems we identified</a> in CMS’ draft regulations. Although CMS granted physicians a <a href="https://www.texmed.org/Template.aspx?id=42189">reprieve</a> from 2019 Medicare payment penalties if they attempt to report some data next year, practices still face a host of decisions about what path they will take to try to comply with the biggest change in Medicare payment policies in more than a generation.</p>
<p>TMA is here to provide guidance:</p>
<p><ul>
<li>Start with our members-only <a href="https://www.texmed.org/5stepmacraready/">Five-Step Checklist for MACRA Readiness</a>. </li>
<li>Sign up for our new statewide seminar series, <a href="https://texmed.inreachce.com/Details?groupId=271377d4-3120-4a38-9346-9940a2ba27b1">MACRA and Medicare — Get Clarity and Direction</a>, beginning Oct. 25. </li>
<li>Attend the <a href="https://www.texmed.org/qualitysummit/">Texas Quality Summit</a>, Nov. 18-19. </li>
<li>Check out these on-demand recordings from our MACRA lunchtime webinars: </li>
<ul>
<li><a href="https://texmed.inreachce.com/Details?groupId=6468e25c-3389-44a9-a7ce-1aad95073299">MACRA Penalties: Neutralize Them With New Revenue</a>, and </li>
<li><a href="https://texmed.inreachce.com/Details?groupId=cdf7d72c-fc0b-4c8b-bda5-4666927c01a5">MACRA: Technology’s Secrets to Success</a>. </li>
</ul>
<li>Contract with <a href="https://www.texmed.org/TMAPracticeConsulting/">TMA Consulting Services</a> for a MACRA readiness assessment of your practice.</li>
</ul></p>
<p>For all the latest, visit TMA's online <a href="http://www.texmed.org/macra">MACRA Resource Center</a> regularly.</p>
<div class="blogger-post-footer">http://feeds.feedburner.com/bloggedarteries</div>Steve Levinehttp://www.blogger.com/profile/05032341081521706316noreply@blogger.com0tag:blogger.com,1999:blog-13146143.post-67421117079539904512016-09-15T10:31:00.001-05:002016-09-15T10:31:54.042-05:00Does the government know what it’s doing to physicians?<b>By Don R. Read, MD</b><br />
<b>President, Texas Medical Association</b><br />
<br />
<i>(This article first appeared in the <a href="http://www.kevinmd.com/blog/2016/09/government-know-whats-physicians.html" target="_blank">KevinMD.com</a> blog. Reprinted with permission.)</i><br />
<br />
Physicians spend almost twice as much time each day typing on computers and filling out paperwork as they do seeing patients. That astonishing conclusion comes from research published this week in the Annals of Internal Medicine.<br />
<br />
Just think about that. How would you feel if you spent two hours documenting every hour of work that you do? How would your boss feel about it? You’d be depressed and frustrated; your boss would probably be angry as hell.<br />
<br />
Patients should be up in arms over this report. Taxpayers should be up in arms. Physicians already are up in arms because we already knew this was true — and we know it’s just going to get worse.<br />
<br />
We know it’s going to get worse because we know what’s causing it in the first place.<br />
<br />
And that’s what’s missing in this study. Why? Why do physicians spend just 27 percent of their time “on direct clinical face time with patients” and 49.2 percent on electronic health records (EHRs) and “desk work”? From my nearly 50 years in medicine and thousands of conversations I’ve had with my colleagues, I can guarantee you it’s not a willing choice.<br />
<br />
But again, the question is “why.” Why is this happening? Part of it has to do with EHR systems that appear to have been designed by someone who never set foot in a physician’s exam room. They’re clunky, not intuitive, and don’t fit the flow of how we examine, diagnose, and interact with our patients.<br />
<br />
But the bigger issue is why we have to enter all of this data into a computer system in the first place. It comes back to an alphabet soup of government regulations that definitely were written by someone who’s never been in the exam room with a patient. The Physician Quality Reporting System (PQRS), Meaningful Use (MU), and the Value-Based Payment Modifier (VBM) program all aim to “capture” the quality of care we’re providing and score us on the cost of that care. MU — the worst-named government program ever — actually cuts our Medicare payments if we don’t use an EHR.<br />
<br />
A study published in Health Affairs earlier this year estimates the cost in physician time to comply with just one of those programs, PQRS, exceeds $50,000 per primary care physician per year. That’s a lot of money; but it’s also a lot of our time. That’s time the government has stolen from our patients.<br />
<br />
And — as I mentioned earlier — it’s only going to get worse. The Merit-Based Incentive Payment System (MIPS), part of the Medicare Access and CHIP Reauthorization Act (MACRA), begins in January. MIPS is supposed to replace PQRS, MU, and VBM. But, as I wrote in this space in June, the new program looks to be far more costly, complex, and confusing than the costly, complex, and confusing programs it is replacing.<br />
<br />
The Centers for Medicare & Medicaid Services (CMS) estimates MACRA will add $128 million a year in compliance costs above the costs of complying with the programs it is replacing. Texas Medical Association analysis finds that “official” number woefully low.<br />
<br />
And all of that brings us to one more, even bigger question: Does the government know what it’s doing to physicians?<br />
<br />
We went to medical school and dedicated our lives to helping people heal and stay healthy, not to become data entry operators. But that’s what we have become, and that’s taking a toll on physicians, our patients, and the entire health care system. Physicians are burned out and unhappy, patients have less time with their doctors, and everyone has to pay more to get less care.<br />
<br />
I’ve been a patient — a seriously ill patient — and I owe my life to the physicians who helped me recover from West Nile virus encephalitis. Like every patient, I don’t want a burned-out, unhappy doctor who’s enslaved by his computer. I want a bright-eyed, engaged, and satisfied physician who has the time and energy to put me — and my health — first.<br />
<br /><div class="blogger-post-footer">http://feeds.feedburner.com/bloggedarteries</div>Me and My Doctorhttp://www.blogger.com/profile/14771175740273059876noreply@blogger.com0tag:blogger.com,1999:blog-13146143.post-38777102911924076362016-07-12T11:56:00.002-05:002016-07-12T11:58:39.889-05:00"We have deliberately set the game so that you cannot win"<p>Shortly before a senior Medicare official came to visit his Dallas office in late June, Texas Medical Association President Don R. Read, MD, shared with <em>Texas Medicine</em> his thoughts on the agency's draft rules implementing the Medicare Access and CHIP Reauthorization Act (MACRA). Dr. Read compared changing complexity of Medicare rules to a progression from a simple game of checkers to a new game no one understands, whose rules are written in Mayan hieroglyph, and which "you cannot win."</p>
<b><p>Listen to the <a href="https://www.texmed.org/uploadedFiles/Current/2016_Practice_Help/Clinical_Quality_and_Payment/MACRA/Read-TheMACRAgame.mp3" title="The MACRA Game" target="_blank">short audio clip</a>, or read the full transcript below.</p></b>
<p> </p>
<hr />
<p> </p>
<div class="separator" style="clear: both; text-align: center;"><a href="https://2.bp.blogspot.com/-kZcxUTUA0fk/V3agkEAyZAI/AAAAAAAAIMM/5hkWRSOzUQcGpLWjmea_FdKOTy81KploQCKgB/s1600/01da8ebd712e4c15fa8d41ded7f01ebe9ad3126a9c.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" src="https://2.bp.blogspot.com/-kZcxUTUA0fk/V3agkEAyZAI/AAAAAAAAIMM/5hkWRSOzUQcGpLWjmea_FdKOTy81KploQCKgB/s200/01da8ebd712e4c15fa8d41ded7f01ebe9ad3126a9c.jpg" width="200" height="134" /></a></div><p>“This is how MACRA comes across to me. With original Medicare, we were playing checkers. There were some rules we didn’t agree with, some that were truly stupid, like you couldn’t pay for a TPN outside the hospital, which was much cheaper so we had to keep them in the hospital which was much more expensive, but you pretty much understand the rules. Then with PQRS and MU, we started playing chess. Kind of easy chess, but we were starting to play chess. <br /><br />“And now you say, well we’re going to change the game. It’s not checkers; it’s not chess; it’s something new. The board’s got two more columns and two more rows. Some of the chess pieces are the same, but we’ve put new ones out there. And we’ve written rules. We started to write them in Mandarin Chinese, but we figured you’d be able to get an interpreter and interpret them, so we’ve written them in Mayan hieroglyphs to make sure you don’t understand.<br /><br />“But you have to start playing right away, and don’t worry about the fact that you don’t understand the rules because we have deliberately set the game so that you cannot win.<br /><br />“And by the way, two years from now you’re going to get penalized because you did not win.”<br />  </p><div class="blogger-post-footer">http://feeds.feedburner.com/bloggedarteries</div>Steve Levinehttp://www.blogger.com/profile/05032341081521706316noreply@blogger.com0tag:blogger.com,1999:blog-13146143.post-73833321669927080562016-07-01T12:03:00.000-05:002016-07-01T12:03:17.305-05:00Medicare Man Enters the Maw of MACRA Malcontent<div class="MsoNormal">
To hear Dallas physician leaders Don Read, MD, and Rick
Snyder, MD, tell it, if they can’t make it, no one can. And right now, Drs.
Read and Snyder are extremely pessimistic about their practices being able to “make
it” under Medicare’s proposed new quality regulations.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
A top Medicare official, who made the trek to Dallas at the
invitation of the Texas Medical Association, appeared to be listening.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: left; text-align: left;"><tbody>
<tr><td style="text-align: center;"><a href="https://3.bp.blogspot.com/-kZcxUTUA0fk/V3agkEAyZAI/AAAAAAAAIMA/8UsiAXNYUL8sYH45HKfcp0Nj2ZiRF5K2ACLcB/s1600/01da8ebd712e4c15fa8d41ded7f01ebe9ad3126a9c.jpg" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="267" src="https://3.bp.blogspot.com/-kZcxUTUA0fk/V3agkEAyZAI/AAAAAAAAIMA/8UsiAXNYUL8sYH45HKfcp0Nj2ZiRF5K2ACLcB/s400/01da8ebd712e4c15fa8d41ded7f01ebe9ad3126a9c.jpg" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Dr. Read: Without big changes, small practices<br />"are going to fail" under MACRA</td></tr>
</tbody></table>
“We are light years ahead of small practices, who are in
survival mode all the time, in terms of reporting quality,” Dr. Read, the
current TMA president, and head of a the 14-physician Texas Colon & Rectal
Specialists, told Tim Gronniger, the deputy chief of staff at the Centers for
Medicare & Medicaid Services (CMS).<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
“We are going to fail on the quality measures, which is
something this practice prides itself on,” added Nancy Bowman, executive
director for the practice.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Despite the practice’s large investment in health care
information technology – about $300,000 on software alone in 2015 – Ms. Bowman
said neither the group nor its advanced electronic health record (EHR) system
vendor will be ready when it’s time to collect the new MACRA data on Jan. 1,
2017.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Dr. Read followed up with a theme that permeated TMA’s <a href="http://tma.tips/MACRAcomment">26-page official comment letter</a> to CMS
on the proposed rules implementing the Medicare Access and CHIP Reauthorization
Act (MACRA). <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
“All these small practices are doomed to fail under this
system,” he told Mr. Gronniger. “It's not worth their spending money to
participate in a system where they're going to fail.”<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: left; margin-right: 1em; text-align: left;"><tbody>
<tr><td style="text-align: center;"><a href="https://4.bp.blogspot.com/-K0mf31V72Yo/V3agkMfrBcI/AAAAAAAAIME/8b7qmT4rQakfVfp-vXBOdzchbj7AYzGSwCKgB/s1600/01d019a4ca66af231e8293d4821f23f7bb2e87a222.jpg" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="160" src="https://4.bp.blogspot.com/-K0mf31V72Yo/V3agkMfrBcI/AAAAAAAAIME/8b7qmT4rQakfVfp-vXBOdzchbj7AYzGSwCKgB/s200/01d019a4ca66af231e8293d4821f23f7bb2e87a222.jpg" width="200" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Tim Gronniger, deputy chief of staff,<br />
Centers for Medicare & Medicaid Services</td></tr>
</tbody></table>
Mr. Gronniger acknowledged that CMS has heard that complaint
from many quarters, including TMA’s official comment letter. “I hear your
concern that it's too complicated,” he said “We're getting feedback that there’s
too many things to think about.” He also promised that CMS would provide
physicians with “bite-sized” instructions on how to comply with the MACRA
requirements.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
The agency is reviewing all of the feedback it has received
on the draft rule, and will issue a final regulation around Nov. 1.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
An hour later, Mr. Gronniger walked down the hall to hear
from Dr. Snyder, whose 70-physician practice is the state’s largest independent
cardiology group and one of the largest in the nation.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
“We pride ourselves on being cutting edge on regulatory
compliance,” Dr. Snyder told him. “There's no way in the world we are going to
be ready Jan 1. Our goal is just not to lose money.”<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://4.bp.blogspot.com/-bgv91xTKq2w/V3agkCRhudI/AAAAAAAAIMM/84_1Ejs1ZzUFnmc8nhxY0JUGAe-kj7ndgCKgB/s1600/01542080444546a27fcedc7bb070d56be356d5ec99.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="257" src="https://4.bp.blogspot.com/-bgv91xTKq2w/V3agkCRhudI/AAAAAAAAIMM/84_1Ejs1ZzUFnmc8nhxY0JUGAe-kj7ndgCKgB/s400/01542080444546a27fcedc7bb070d56be356d5ec99.jpg" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Dr. Snyder presses Mr. Gronniger for an "independent practice pathway."</td></tr>
</tbody></table>
Dr. Snyder said his big-picture concern is that the rule as
written will “accelerate the consolidation” of independent physician practices
into hospital systems. That, he said, would increase costs to Medicare and give
patients fewer choices.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
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“Please come up with an independent practice pathway,” Dr.
Snyder told Mr. Gronniger. “Make it friendly so we can increase quality, reduce
costs and remain independent, because we think that's the best model.”</div>
<br />
<div class="MsoNormal">
Mr. Gronniger said he liked that idea and would work to
modify the rule to make that happen.<br />
<o:p></o:p></div>
<div class="blogger-post-footer">http://feeds.feedburner.com/bloggedarteries</div>Steve Levinehttp://www.blogger.com/profile/05032341081521706316noreply@blogger.com1tag:blogger.com,1999:blog-13146143.post-45516601811406340482016-06-21T13:15:00.000-05:002016-06-21T13:15:03.704-05:00MACRA Rule: Not What Congress Ordered<div align="center" class="MsoNormal" style="text-align: center;">
<b></b><br />
<b>By Don Read, MD</b><b>President, Texas
Medical Association</b><br />
<b><br /></b></div>
<div align="center" class="MsoNormal" style="text-align: center;">
</div>
<div style="text-align: center;">
(<i>This article first appeared in the <a href="http://www.kevinmd.com/blog/2016/06/macra-rule-not-congress-ordered.html" target="_blank">KevinMD.com blog</a>. Reprinted with permission.</i>)
</div>
<br />
I joined
physicians nationwide last year in cheering when Congress passed the Medicare
Access and CHIP Reauthorization Act of 2015 (MACRA). Not only did it eliminate
the congressional budgetary fiction known as the Sustainable Growth Rate (SGR)
formula, it also promised to simplify and improve Medicare’s costly and complex
programs that purport to measure the quality of care we provide to our
patients.<br />
<br />
Unfortunately,
as we review the draft implementing rule, it appears that the net result will
be neither simplified nor improved. Frankly, while we see the need for some
legislative tweaks, this proposed rule is not what Congress ordered.<br />
<br />
MACRA
already has accomplished two of its intended goals. It reauthorized the
Children’s Health Insurance Program for two years, and it removed the constant
threat of SGR-driven Medicare payment cuts. The SGR’s faulty assumptions would
have forced annual fee cuts for physicians for every one of the past 15 years.
The obvious folly of that policy drove Congress to override each of those cuts
since 2002, often in desperate, last-minute or retroactive circumstances. The
associated financial threats and uncertainty about business viability created
continuously hazardous conditions for physicians.<br />
<br />
MACRA also
promised to simplify the ever-tightening thicket of federal regulations that
strangle physicians’ practices. The draft regulations that the Centers for
Medicare & Medicaid Services (CMS) published on May 9 fall far short of
that promise. If implemented as written, they would dump additional
bureaucratic work on physicians and their practices, and would continue to
impose onerous federal controls on physicians and their practices — with no
data to show that they would improve the quality of or access-to-care for
patients. The system devised by CMS is far more costly, complex, and confusing
than the costly, complex, and confusing programs it is replacing. Compliance
would be especially difficult for small practices who may end up with Medicare
payment penalties even if they spend the time and money to jump through all the
new regulatory hoops. The budget-neutral system of bonuses and penalties pits
physician practices against each other, so that there will be annually anointed
winners and losers regardless of how well all practices “perform” on these new
quality standards.<br />
<br />
When MACRA
legislation was enacted, TMA had no reason to expect CMS would propose to
continue flawed concepts from the current quality programs along with plans to
diminish a physician’s worth down to a complex point system. More disappointing
is to learn that CMS proposes to design a program that is stacked against solo
physicians and small group practices in its first year of implementation.<br />
<br />
CMS and
proponents of the agency’s proposed plan say it will streamline the current
quality reporting systems and simplify the transition to value-based care. CMS
Acting Administrator Andy Slavitt says “we have to get the hearts and minds of
physicians back,” and he claims MACRA will “put physicians back in control.”
Our analysis of the proposed regulations reveals something much to the
contrary.<br />
<br />
We found:<br />
<ul>
<li><u>Costly
Reporting and Compliance:</u><br />The
compliance, documentation, and reporting requirements related to the new
combined incentive programs are inordinately costly for many physicians. CMS’
own figures show the new programs will add additional compliance costs of $128
million above the cost of the programs it is replacing.<br /></li>
<li><u>Disjointed
Timelines and Perverse Incentives:</u><br />CMS has failed to properly engage physicians and guide them to
successful
participation since the current program began in 2007. The replacement does
little to reverse the problems in the current systems, and in fact immediately
increases the requirements for “success.” The first year of implementation is
not the time to raise the bar and increase the degree of difficulty in meeting
quality reporting requirements.<br /></li>
<li><u>Metrics
Outside of Physician Control:</u><br />Vendors
and patients, not physicians, have control over meeting MACRA’s
standards and requirements. Physicians should not be penalized for the failures
of their electronic health record (EHR) vendors or for the demographic or
socioeconomic status of their patients.<br /></li>
<li><u>Two
Years Too Late:</u><br />CMS plans to use two-
year-old data to determine whether physicians receive a
bonus or penalty. Data from 2017 will be used in 2019, 2018 data in 2020, and
so on. At no point in the process will physicians be provided feedback on their
current performance data or insights within the current performance year on how
to improve their status, and no objective standard will exist for physicians to
target. Physicians should be given real-time and correct information on their
practices.<br /></li>
<li><u>Arbitrary
Incentives to Create Massive Changes in Physician Practice Type:</u><br />The need for sophisticated support systems, the
inflexibility of the
measurement standards, and the lack of realistic incentives to change all
create pressures for physicians to abandon small practices to join large ones —
or to sell out to hospitals. In fact, CMS’ published data shows that payment
penalties could decimate small practices, still the majority in
Texas.<br /></li>
<li><u>Cost
Without Benefit to Medicare:</u><br />There is
no evidence that the incentives in the draft MACRA regulations are
likely to be effective in improving care quality or increasing efficiency.
Requirements should include only activities proven to actually enhance care
quality, or to reduce cost with no adverse impact on quality, access, or
productivity.</li>
</ul>
The nearly
50,000 physician and medical student members of the Texas Medical Association
urge
the leadership of CMS to chart a different course of action. We call on them to
take the time necessary to ensure that this new law supports and enhances the
physicians who provide the medical care to our nation’s 54 million Medicare
beneficiaries. We urgently request that CMS stop moving down a path that
threatens to plow under tens of thousands of physician practices and needlessly
create an access crisis for patients covered by Medicare. <br />
<br />
In general
we are asking for time, fairness, simplicity, and flexibility. More precisely:
<br />
<ul>
<li>Exempt
physicians who have no possibility of earning more than it costs them to report
data, and do not force physicians into unacceptably risky payment
models.<br /></li>
<li>Establish
objective and timely measurement and reporting systems that are simpler and
less costly than those currently required. The focus should be improving care
for all Medicare patients, not creating yearly physician winners and losers
with payment affected two years after care has been delivered.</li><br />
<li>Use
quality metrics that capture those activities that are under the physician’s
control and have been shown to improve quality of care, enhance access-to-care,
and/or reduce the cost of care. The focus should be on metrics that are most
meaningful to a practice and its patients, not on what will result in the best
“score.”<br /></li>
<li>Allow
physicians who want to shift to value-based care enough time to make this
transition in a way that actually benefits their patients and does not cause
undue collateral damage to their practices.<br /></li>
<li>Require
EHR vendors to build and maintain products that meet federal specifications
rather than forcing physicians to purchase and constantly upgrade expensive and
often-balky systems.</li>
</ul>
Last week
I sat in the American Medical Association audience when Acting Administrator
Slavitt said, “I am convinced that adding new regulations to an already busy
health care system without improving how the pieces fit together just will not
work.” He also said he wants to hear what practicing physicians think about
this draft rule.<br />
<br />
This
practicing physician is telling Mr. Slavitt his plan just will not work. Change
it.<br />
<div class="blogger-post-footer">http://feeds.feedburner.com/bloggedarteries</div>Steve Levinehttp://www.blogger.com/profile/05032341081521706316noreply@blogger.com0tag:blogger.com,1999:blog-13146143.post-12616606679565153772016-06-12T11:02:00.000-05:002016-06-14T16:05:07.282-05:00VA Official Defends Proposed Scope of Practice Change<div class="MsoNormal">
<span style="font-family: "arial";">(CHICAGO) - The Department
of Veterans Affairs’ plan to allow advance practice nurses (APRNs) to practice
independently within the VA is “all about access,” a top official in the VA
health care system told Texas physicians today.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div style="text-align: left;">
</div>
<div class="MsoNormal">
<span style="font-family: "arial";">"When we say
independent practice for nurse practitioners, that's in the context of team-based
care," a senior VA health official told the Texas Delegation to the American
Medical Association. "I don't even know what an independent practitioner
in the VA system would mean."<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "arial";">The official said VA “bet the farm
around 2010 on the patient-centered medical home model” and depends on APRNs to
help meet veterans’ growing demand for care within the VA system.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "arial";">The Texas physicians, which
included a number of military veterans, peppered the official with tough
questions.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "arial";">"Veterans deserve the
highest and best care,” said Beaumont anesthesiologist Ray Callas, MD, a decorated
U.S. Navy veteran of Operation Desert Storm. “In the most complicated cases,
anesthesiologists should be in the lead."<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "arial";">Last month, the VA published
a proposed rule that would allow APRNs — nurse anesthetists, nurse
practitioners, nurse midwives, and clinical nurse specialists — to practice
independently within the VA health system. While this doesn't change state
scope-of-practice laws for APRNs working outside the VA system, it overrides
those laws for care being provided inside the VA. <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "arial";">Veterans' service
organizations and more than 90 members of Congress are opposing this change on
the grounds it jeopardizes veterans' safety. Comments on the draft rule are due
July 25. TMA, the American Medical Association, the Coalition of State Medical Societies, and other medical societies
will file formal comments in strong opposition.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "arial";">The draft rule has stirred a
storm of protest, particularly from anesthesiologists. The official said the VA
already has received about 20,000 comments on the proposal, more than it has
ever received on a proposed rule.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "arial";">TMA urges Texas doctors to
take a few minutes to tell VA officials what they think of the plan. Submit
comments on the <a href="http://txma.informz.net/z/cjUucD9taT01MzExNjUyJnA9MSZ1PTc3NjkzODMwMyZsaT0zNTQ2NDU5OQ/index.html">government's
rulemaking website</a> or through the American Society of Anesthesiologists' <a href="http://txma.informz.net/z/cjUucD9taT01MzExNjUyJnA9MSZ1PTc3NjkzODMwMyZsaT0zNTQ2NDYwMA/index.html">Safe
VA Care website</a>.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "arial";">Despite the official's talk of
team-based care, Fort Worth pediatrician Gary Floyd, MD, said an important
phrase is missing in the VA’s draft rule. “It needs to be ‘physician-led,’” he
said. “Please put that language back in.”<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "arial";">If the VA adopts the rule as
written, Dr. Floyd said, groups like TMA will find it more difficult to protect
physician-led team-based care in state legislatures.</span><br />
<span style="font-family: "arial";"><br /></span>
<span style="font-family: "arial";">“It needs to be a physician-led team, whether it's CRNAs or primary care,” he said. “That is the hallmark of quality care.”</span></div>
<div class="blogger-post-footer">http://feeds.feedburner.com/bloggedarteries</div>Steve Levinehttp://www.blogger.com/profile/05032341081521706316noreply@blogger.com1Hyatt Regency Chicago, Chicago, IL 60601, USA41.8874309 -87.62180030000001841.8859534 -87.624321800000018 41.8889084 -87.619278800000018tag:blogger.com,1999:blog-13146143.post-62519706582602464872016-03-02T11:39:00.000-06:002016-03-02T11:43:15.803-06:00Wednesday Morning Memo: Election Day Turns Out Great for Doctors, Patients – and #TEXPAC<i><p>By Steve Levine<br />
TMA VP – Communications</p></i>
<p> </p>
<p>While much of the state was engrossed in the obviously engrossing Super Tuesday presidential primary results last night, the Texas Medical Association and TEXPAC teams were studying the legislative and congressional races that will have a big impact on medicine going forward. </p>
<p>Bottom line: we liked what we saw in the party primaries for the Texas House and Senate and U.S. Congress. The candidates who support patients and physicians, by and large, did well – some surprisingly well.</p>
<p>We have a few important runoffs coming up on May 24, and the November general elections will be important at the top of the ballot and for some local races. But most of the makeup of the 2017 Texas Legislature and the 2017 Texas delegation in Congress was decided yesterday.</p>
<p>As TEXPAC Board Chair Brad Holland, MD, pointed out last month, “With so few competitive districts around the state, the action is now, in the party primaries. The men and women who win their party’s nominations in the next few weeks very likely will be the people who will be making the final decisions in the legislature and in the courtrooms next year.”</p>
<p>See all of <a href="https://www.texpac.org/tmaimis/Texpac/Our_Endorsement_Process/TEXPAC_Endorsement_List/Texpac/Endorsement/Current_TEXPAC_Endorsement.aspx">TEXPAC's endorsed candidates</a> in the March 1 races and a description of <a href="https://www.texpac.org/tmaimis/Texpac/Our_Endorsement_Process/Texpac/Endorsement/Our_Endorsement_Process.aspx">how TEXPAC decides who to endorse</a>.</p>
<p>Here’s our wrap-up of key TEXPAC victories:</p>
<b><p>Texas House of Representatives:</p></b>
<ul>
<li>Speaker Joe Straus won easily against an onslaught of money and words from outside his San Antonio district.</li>
<li>State Affairs Committee Chair Byron Cook of Corsicana, Insurance Committee Chair John Frullo of Lubbock, and Insurance Committee Vice Chair Sergio Muñoz of Palmview all defeated strong challengers.</li>
<li>Former State Rep. High Shine of Temple ousted Rep. Molly White of Belton, who had medicine's second-worst voting record in the 2015 legislative session.</li>
<li>Key allies of doctors and patients – Reps. J.D. Sheffield, DO, of Gatesville; Jason Villalba of Dallas; Sarah Davis of West University Place; and Cindy Burkett of Sunnyvale – all came home winners.</li>
<li>There will be another doctor in the House: Anesthesiologist Tom Oliverson, MD, of Houston won his primary and is unopposed in the fall.</li>
<li>TEXPAC-endorsed candidates won in three other open House seats. In a fifth open seat to replace retiring Public Health Committee Chair Myra Crownover of Denton, the TEXPAC-supported candidate is leading going into the May 24 runoff.</li></ul>
<b><p>Texas Senate</p></b>
<ul>
<li>In Senate District 24, we couldn't ask for anything better. Both of TEXPAC’s endorsed candidates -- one an active TMA leader (ophthalmologist Dawn Buckingham, MD, of Lakeway) and one a nurse married to a TMA past president (Rep. Susan King of Abilene) – are headed to the May 24 runoff.</li>
<li>The TEXPAC-endorsed candidate in Senate District 1 in East Texas is leading big going into the other Senate open seat runoff.</li></ul>
<b><p>U.S. House of Representatives</p></b>
<ul>
<li>Ways and Means Committee Chair Kevin Brady of The Woodlands defeated three opponents to win. His committee has primary jurisdiction over Medicare.</li>
<li>Medicine’s champion – Rep. Michael Burgess, MD, of Denton, the only TMA member in Congress, architect of the bill that repealed Medicare’s hated Sustainable Growth Rate (SGR) formula -- won handily.</li>
<li>Rep. Gene Green of Houston – ranking member of the Subcommittee on Health – won his race.</li></ul>
<div class="blogger-post-footer">http://feeds.feedburner.com/bloggedarteries</div>Steve Levinehttp://www.blogger.com/profile/05032341081521706316noreply@blogger.com0tag:blogger.com,1999:blog-13146143.post-5328386912016545902015-11-10T16:30:00.000-06:002015-11-10T16:30:12.883-06:00How to spur Congress to act: 7 essential elements of storytelling<div style="-ms-word-wrap: break-word; -webkit-text-stroke-width: 0px; background-color: white; color: #1a1414; font-family: Gotham, "Helvetica Neue", Helvetica, Arial, sans-serif; font-size: 13px; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; margin-bottom: 15px; margin-top: 0px; overflow: hidden; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 1; word-spacing: 0px;">
<em>Republished with permission from AMA Wire®</em><br />
<br /><br />
The struggle with electronic health records (EHR) is real, and <a href="http://www.texmed.org/leg" target="_blank">Congress needs to hear from physicians</a>. But how can you make your story compelling? How can you pen a tale that cuts to the heart of the matter and inspires your members of Congress to take action? These seven elements of storytelling—recommended by an expert on engaging members of Congress—will help you craft the most potent version of your story.<br />
<br />
<div style="-ms-word-wrap: break-word; -webkit-text-stroke-width: 0px; background-color: white; color: #1a1414; font-family: Gotham, "Helvetica Neue", Helvetica, Arial, sans-serif; font-size: 13px; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; margin-bottom: 15px; margin-top: 0px; overflow: hidden; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 1; word-spacing: 0px;">
In an AMA <u><span style="color: #0066cc;">Very Influential Physicians (VIP)</span></u> webinar last week, Brad Fitch, president and CEO of the Congressional Management Foundation, delivered expert advice on how physicians can compose and position their personal EHR stories in an effort to persuade Congress to take action against meaningful use Stage 3 and further progression of the program’s troublesome regulations.<a href="http://pluck.ama-assn.org/static/images/store/7/0/57f8323e-ea0b-4c48-b069-8b17f6d8c503.Full.jpg?1" style="-ms-word-wrap: break-word; color: #0066cc; cursor: pointer; overflow: hidden; text-decoration: underline;" target="_blank"><img src="http://pluck.ama-assn.org/static/images/store/7/0/57f8323e-ea0b-4c48-b069-8b17f6d8c503.Large.jpg?1" style="border-image: none; border: 0px currentColor; float: right; margin: 15px;" /></a></div>
<div style="-ms-word-wrap: break-word; -webkit-text-stroke-width: 0px; background-color: white; color: #1a1414; font-family: Gotham, "Helvetica Neue", Helvetica, Arial, sans-serif; font-size: 13px; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; margin-bottom: 15px; margin-top: 0px; overflow: hidden; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 1; word-spacing: 0px;">
<strong style="font-weight: 700;">Why is storytelling important for this cause?</strong></div>
<div style="-ms-word-wrap: break-word; -webkit-text-stroke-width: 0px; background-color: white; color: #1a1414; font-family: Gotham, "Helvetica Neue", Helvetica, Arial, sans-serif; font-size: 13px; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; margin-bottom: 15px; margin-top: 0px; overflow: hidden; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 1; word-spacing: 0px;">
Storytelling is a key part of the psychology of persuasion. We feel, and then we decide. In order for Congress to understand the detrimental effect meaningful use regulations have on daily practice, physicians need to deliver a perspective that will show the impact on their lives and the lives of their patients.</div>
<div style="-ms-word-wrap: break-word; -webkit-text-stroke-width: 0px; background-color: white; color: #1a1414; font-family: Gotham, "Helvetica Neue", Helvetica, Arial, sans-serif; font-size: 13px; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; margin-bottom: 15px; margin-top: 0px; overflow: hidden; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 1; word-spacing: 0px;">
Members of Congress deal with a lot of data, spreadsheets and graphs every day, Fitch said. This type of information is being delivered to them all the time. But only physicians can communicate the personal stories from the front lines and drive them to act.</div>
<div style="-ms-word-wrap: break-word; -webkit-text-stroke-width: 0px; background-color: white; color: #1a1414; font-family: Gotham, "Helvetica Neue", Helvetica, Arial, sans-serif; font-size: 13px; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; margin-bottom: 15px; margin-top: 0px; overflow: hidden; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 1; word-spacing: 0px;">
<strong style="font-weight: 700;">The 7 elements of storytelling</strong></div>
<div style="-ms-word-wrap: break-word; -webkit-text-stroke-width: 0px; background-color: white; color: #1a1414; font-family: Gotham, "Helvetica Neue", Helvetica, Arial, sans-serif; font-size: 13px; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; margin-bottom: 15px; margin-top: 0px; overflow: hidden; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 1; word-spacing: 0px;">
Your story should be brief. One page, single-spaced, is about 500 words. This length will take approximately four to six minutes to read aloud. If a story is too long, your members of Congress could lose interest, particularly with the numerous other demands for their attention, Fitch said, answering a listener’s question</div>
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Mark Twain once said, “I would have written a shorter letter, but I didn’t have the time.” Condensing your story can be difficult, but take the time to make it concise. A shorter story is more memorable and can leave a lasting impression, Fitch said.</div>
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When crafting your story, Fitch recommends using these seven elements of storytelling to most effectively communicate your experience with EHRs and regulations:</div>
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<strong style="font-weight: 700;">1. </strong><strong style="font-weight: 700;">“The Want”:</strong><span class="Apple-converted-space"> </span><strong style="font-weight: 700;">Begin with the end in mind.</strong><br />Know what you want before you begin. Do you want your member of Congress to understand how EHRs have increased costs to your practice or impacted the delivery of care to patients? A good storyteller begins knowing what the end product should deliver emotionally.<br /><br />Consider various tactics and methods to achieve your goal in the story. Your goal can be to flatter, surprise, or evoke empathy or urgency. You are the Steven Spielberg of your story. What effect do you want to have on your audience?</div>
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<strong style="font-weight: 700;">2. </strong><strong style="font-weight: 700;">“The Opening”:</strong><span class="Apple-converted-space"> </span><strong style="font-weight: 700;">Set the stage and establish the stakes.</strong><br />Your first sentence or two should make your reader want to know more. What is at stake for patients, their families or you as the physician providing their care? As much as possible, think about the effect these regulations have on your ability to deliver quality care to your patients.<br /><br />Members of Congress are listening for the component that tells them, “If I don’t do X, then Y will happen.”</div>
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<strong style="font-weight: 700;">3. </strong><strong style="font-weight: 700;">“Paint the Picture”:</strong><span class="Apple-converted-space"> </span><strong style="font-weight: 700;">The details and senses of your story.</strong><br />When you experienced the moment you are writing about, what did you see, hear, touch, taste and smell? These are the elements that will get your members of Congress involved in the story.<br /><br />Remember to use adjectives to enhance the power of your narrative. Make it real. Be practical, specific and graphic—don’t hold anything back! What descriptive words could make your story compelling and interesting? For example, substitute “morose” for “sad” or use the word “devastated” rather than “upset.” These are the kinds of impact words that paint the picture of your story.</div>
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<strong style="font-weight: 700;">4. </strong><strong style="font-weight: 700;">“The Struggle”:</strong><span class="Apple-converted-space"> </span><strong style="font-weight: 700;">Describe the fight.</strong><br />Identify the conflict. Real struggles in life are mental, philosophical, emotional, physical—even internal. Every story has a protagonist and an antagonist, and the interactions between these two is where the conflict lies.<br /><br />Don’t hesitate to play the underdog. Members of Congress love to come to the aid of the underdog. They want to help David win the battle against Goliath. Play that strength.</div>
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<strong style="font-weight: 700;">5. </strong><strong style="font-weight: 700;">“The Discovery”:</strong><span class="Apple-converted-space"> </span><strong style="font-weight: 700;">Always surprise the legislator.</strong><br />What did you learn or realize in the moment of your story? Find this answer and deliver it when it will have the most impact. Then describe how that learning impacted your life, the lives of your patients, the future of your practice and your ability to deliver quality care.<br /><br />You may not have a discovery, but is there a part of your story that might surprise the legislator? If you can add a twist—a moment that truly delivers the scope of your struggle—then use it.</div>
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<strong style="font-weight: 700;">6. </strong><strong style="font-weight: 700;">“We Can Win!”:</strong><span class="Apple-converted-space"> </span><strong style="font-weight: 700;">Introduce the potential of success and joy.</strong><br />Success in a story is when the hero or heroine wins the fight or struggle. Joy is when the audience can participate and take part in the celebration of victory. If you can hook your members of Congress into feeling the impact of success and the joy that will follow, they become a part of your cause.<br /><br />Think: “Senator/Representative, we have the opportunity to ….” Then describe how that victory will enhance your practice and the lives of patients and their families.</div>
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<strong style="font-weight: 700;">7. </strong><strong style="font-weight: 700;">“The Button”:</strong><span class="Apple-converted-space"> </span><strong style="font-weight: 700;">Finish with a hook.</strong><br />As you end your story, come up with a last line your members of Congress will always remember. Be thoughtful when composing your final line. Write it out and make it perfect. Have your ending sentence memorized when you’re speaking in person. This way, your member of Congress will remember it for the rest of the day.<br /><br />Fitch related a particularly salient example. While delivering his story to a Congressman regarding his inability to acquire necessary medication, a veteran described a moment when his granddaughter asked him, “Poppy, why do your hands shake?” He looked at the Congressman and said, “What should I tell her?” This kind of hook will tug at the heart strings of your members of Congress and stay with them.</div>
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Once your story is drafted, revised and final, deliver it to your member of Congress. Visit<span class="Apple-converted-space"> </span><a href="http://breaktheredtape.org/email-congress" rel="nofollow" style="-ms-word-wrap: break-word; color: #0066cc; cursor: pointer; overflow: hidden; text-decoration: underline;" target="_blank">breaktheredtape.org</a><span class="Apple-converted-space"> </span>to send your story directly to Congress by email.</div>
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Remember to take your time. A well-crafted story, no matter how small, can hold remarkable power.</div>
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<strong style="font-weight: 700;">How to more actively reach your members of Congress</strong></div>
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Become a member of the AMA’s<span class="Apple-converted-space"> </span><a href="http://www.ama-assn.org/ama/pub/advocacy/grassroots-advocacy/very-influential-physicians.page?" style="-ms-word-wrap: break-word; color: #0066cc; cursor: pointer; overflow: hidden; text-decoration: underline;" target="_blank">“Very Influential Physicians (VIP)”</a><span class="Apple-converted-space"> </span>program by visiting the AMA Grassroots Advocacy Web page to take part in future activities. You also can log in to view the full<span class="Apple-converted-space"> </span><a href="https://cc.readytalk.com/cc/playback/Playback.do?id=fa1v1a" rel="nofollow" style="-ms-word-wrap: break-word; color: #0066cc; cursor: pointer; overflow: hidden; text-decoration: underline;" target="_blank">7 elements of storytelling webinar</a>.</div>
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<em style="font-style: italic; font-weight: normal;">By AMA staff writer<span class="Apple-converted-space"> </span></em><a href="https://twitter.com/Troy_AMAWire" rel="nofollow" style="-ms-word-wrap: break-word; color: #0066cc; cursor: pointer; overflow: hidden; text-decoration: underline;" target="_blank"><em style="font-style: italic; font-weight: normal;">Troy Parks</em></a></div>
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<div class="blogger-post-footer">http://feeds.feedburner.com/bloggedarteries</div>Steve Levinehttp://www.blogger.com/profile/05032341081521706316noreply@blogger.com0tag:blogger.com,1999:blog-13146143.post-78031966855211394122015-11-09T07:30:00.000-06:002015-11-09T07:30:00.262-06:00Health Insurers’ Narrow Networks Putting Squeeze on PatientsHealth insurance companies are sharply limiting the number of physicians and hospitals they include in their networks as a tool to limit how much they have to pay in covered benefits. Narrow networks are booming in plans sold both through employer-sponsored insurance and on the Affordable Care Act (ACA) marketplace exchanges.<br />
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These moves leave patients out in the cold, and squeezed for the costs of health care the plans aren’t covering. The popular news media and scientific literature have been filled with stories lately about narrow networks. Here’s a roundup.<br />
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<b>ACA Plans Lack Specialists</b></div>
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As many as 14 percent of health plans on the ACA exchanges lack physicians in at least one key specialty. That’s what researchers from Harvard’s T. H. Chan School of Public Health reported in the <i>Journal of the American Medical Association</i>. (“<a href="http://jama.jamanetwork.com/article.aspx?articleid=2466113" target="_blank">Adequacy of Outpatient Specialty Care Access in Marketplace Plans Under the Affordable Care Act</a>,” JAMA, Oct. 27, 2015.)</div>
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“We found this practice among multiple states and issuers,” the authors wrote. “This likely violates network adequacy requirements, raising concerns regarding patient access to specialty care. Such plans precipitate high out-of-pocket costs and may lead to adverse selection (i.e., sicker individuals choosing plans with broader networks), which is similar to concerns over restrictive drug formularies.”</div>
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Rheumatologists, endocrinologists, and psychiatrists were the specialists most often missing from the plans.</div>
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<b>Texas Leads in “X-small” ACA Networks</b></div>
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<a href="http://ldi.upenn.edu/sites/default/files/rte/State_2015_08_18-2.png" imageanchor="1" style="clear: left; display: inline !important; margin-bottom: 1em; margin-right: 1em;"><img border="0" src="http://ldi.upenn.edu/sites/default/files/rte/State_2015_08_18-2.png" height="307" width="400" /></a></div>
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Texas has more “x-small” networks (45 percent) on the ACA exchange than any other state in the network. That’s what the Leonard Davis Institute of Health Economics (LDI) at the University of Pennsylvania found. (“<a href="http://ldi.upenn.edu/sites/default/files/rte/state-narrow-networks.pdf" target="_blank">State Variation in Narrow Networks on the ACA Marketplaces</a>,” published by the Robert Wood Johnson Foundation, August 2015.) Those super-shrunken networks offer access to 10 percent or fewer of the physicians in a rating area. </div>
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This study looked at plans issued by 267 carriers across 355 networks in all 50 states. It used “t-shirt size” ratings of x-small (less than 10 percent), small (10 percent-25 percent), medium (25 percent-40 percent), large (40 percent-60 percent), and x-large (more than 60 percent). The variation was extensive. Some states, such as Delaware, Kansas, and North Dakota, have mostly large or x-large networks. Others don’t at all.</div>
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Here are the states with the most x-small or small networks:</div>
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<li>Georgia – 83 percent</li>
<li>Florida – 79 percent</li>
<li>Oklahoma – 78 percent</li>
<li>California – 75 percent</li>
<li>Texas – 73 percent</li>
<li>Arizona – 73 percent</li>
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In an earlier study, the authors at the Davis Institute found that 41 percent of silver plans on the ACA exchanges were x-small or small. </div>
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<b>Half of ACA Hospital Networks Are Narrow</b></div>
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Patients’ choice of hospitals on the ACA exchange plans is similarly limited. That’s what the McKinsey Center for U.S. Health System Reform found. (“<a href="http://healthcare.mckinsey.com/sites/default/files/2015HospitalNetworks.pdf" target="_blank">Hospital networks: Evolution of the configurations on the 2015 exchanges</a>,” published by McKinsey & Co., April 2015.)</div>
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“Across the country, close to half of the 2015 networks that consumers can choose from are narrowed; in the largest cities, almost two-thirds of the networks are narrowed,” the report states.</div>
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The report defines a “narrow” network as having 70 percent or fewer of local hospitals participating. An “ultra-narrow” network has 30 percent or fewer participating.</div>
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“Many consumers, however, do not appear to understand the choices available to them or the impact of those choices (especially limits on access to care),” McKinsey found. “In our consumer survey, 44 percent of those who bought an ACA plan for the first time this year reported that they did not know the network configuration associated with their plan.”</div>
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<b>Half of ACA Plans Don’t Cover Out of Network</b></div>
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Another study found that 47 percent of the plans sold on the federal ACA exchange have no coverage for out-of-network care. In Texas, that number is 67 percent. (“<a href="https://www.healthpocket.com/healthcare-research/infostat/out-of-network-coverage-in-obamacare-plans#.Vjp_jLerR9M" target="_blank">Almost Half of Obamacare Plans on Federal Marketplace Lack Out-Of-Network Coverage</a>,” published by HealthPocket, Oct. 7, 2015.)</div>
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That, HealthPocket explains, means “the plans will not cover the costs except in the case of a medical emergency or if a prior authorization from the plan had been formally submitted and then approved by the health plan.”</div>
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<b>Narrow Networks Forcing Patients to the ED</b></div>
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Because of narrow networks, a survey of emergency department doctors found, patients are showing up sicker in the emergency department. Also, emergency physicians are finding fewer primary care doctors and specialists to whom they can refer patients for follow-up. (“<a href="http://newsroom.acep.org/download/2015+ACEP+Health+Insurance+Report.pdf" target="_blank">Insurance Industry Drives Patients to Sacrifice Necessary Medical Care</a>,” published by American College of Emergency Physicians [ACEP], Oct. 26, 2015.)</div>
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Specifically, the national study of emergency physicians found:</div>
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<li>73 percent of the doctors see more Medicaid patients because insurance companies don’t provide enough primary care or specialty physicians for their patients.</li>
<li>65 percent see more patients in the emergency department, in large part because health insurance companies don’t provide enough primary care physicians to support the community.</li>
<li>60 percent have difficulty finding specialists for their patients, because of narrow networks.</li>
<li>More than 80 percent treat patients who said they had difficulty finding specialists to care for them because health plans have narrow networks. </li>
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“This is a scary environment for patients,” said Jay Kaplan, MD, president of ACEP. “The insurance companies are shifting costs onto patients and medical providers as they attempt to increase their bottom lines, and this threatens the foundation of our nation’s medical care system.”</div>
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<b>Health Plans Mount Lackluster PR Campaign</b></div>
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Trying to escape the cascade of negative publicity, the insurance industry issued a report blaming physicians’ overcharges for medical care as the cause of “surprise bills.” (“<a href="http://www.houstonchronicle.com/news/houston-texas/houston/article/Texas-doctors-insurers-taking-balance-billing-6565359.php" target="_blank">Texas doctors, insurers taking ‘balance billing’ fight public</a>,” <i>Houston Chronicle</i>, Oct. 11, 2015; “<a href="http://www.quorumreport.com/Quorum_Report_Daily_Buzz_2015/doctors_fire_back_at_insurance_industry_report_on__buzziid24425.html" target="_blank">Doctors fire back at insurance industry report on what Texans are charged for ER visits</a>,” <i>Quorum Report</i>, Oct. 8, 2015)</div>
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It didn’t work. The news media saw right through it and reported this comment from TMA President Tom Garcia, MD:</div>
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This so-called report is nothing more than a desperate smoke screen to divert attention from the real problem. The health insurance industry games the system to keep more of patients’ premium dollars by forcing patients to seek care out of network. Then they have the gall to criticize what some doctors’ bill for that care.</blockquote>
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And the <i>San Antonio Express-News</i> <a href="http://www.mysanantonio.com/opinion/commentary/article/Don-t-ignore-insurers-role-in-balanced-6590543.php" target="_blank">published a response</a> to the study from William W. Hinchey, MD. </div>
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“Insurers want your local pathologist in the network only for inpatient hospital services but not for your outpatient services — even when the pathologist wants to be in your network for both,” Dr. Hinchey explained. “The insurance company ultimately decides who will be in or out of your network. Essentially the insurers are saying to the physicians: We want you some of the time but not all the time.”<br />
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<b>The Real Truth About Balance Billing</b></div>
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A <a href="http://www.texmed.org/Template.aspx?id=33050" target="_blank">TMA study</a> examines how insurance plans’ network designs and payment decisions leave many Texans with “surprise bills” for health care services.</div>
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Inadequate and limited physician networks that insurers sell today are leaving patients with unpaid bills. Unfortunately, Texas consumers are learning the limits of the coverage they bought just when most need coverage, especially in emergencies. The consumer is no longer satisfied with the not-very-well-explained, varying levels of savings that insurance networks create, especially if that means a greater financial burden in emergencies. Yet, despite network shortcomings, consumers do not want to be left without the choice of plans that offer network benefits.</div>
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Check out our white paper: “<a href="http://www.texmed.org/uploadedFiles/Current/Advocacy/Health_Care_Delivery/Health_Insurance/Network%20Adequacy%20White%20Paper%20-%20Final.pdf" target="_blank">Putting the Pieces Together: Network Inadequacy and Unfair Discrimination in Insurance.</a>”</div>
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<div class="blogger-post-footer">http://feeds.feedburner.com/bloggedarteries</div>Steve Levinehttp://www.blogger.com/profile/05032341081521706316noreply@blogger.com0tag:blogger.com,1999:blog-13146143.post-1616400546798769652015-11-05T13:32:00.000-06:002015-11-05T13:32:05.007-06:00What Exactly IS Wrong With EHRs?<p>Many thanks to David Fleeger, MD, of Austin, a member of the TMA Board of Trustees, for taking the time to explain electronic health records and Meaningful Use on this TV show. He even managed to work in "Meaningless Use."</p>
<p><blockquote class="twitter-tweet" lang="en"><p lang="en" dir="ltr">ICYMI: <a href="https://twitter.com/texmed">@texmed</a>'s Dr. David Fleeger discusses growing concern among doctors about electronic health records <a href="https://t.co/x17Oilhq5p">https://t.co/x17Oilhq5p</a> <a href="https://twitter.com/hashtag/txlege?src=hash">#txlege</a></p>— TX Capital Tonight (@TXCapTonight) <a href="https://twitter.com/TXCapTonight/status/662326087452483584">November 5, 2015</a></blockquote>
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</p><div class="blogger-post-footer">http://feeds.feedburner.com/bloggedarteries</div>Steve Levinehttp://www.blogger.com/profile/05032341081521706316noreply@blogger.com0tag:blogger.com,1999:blog-13146143.post-67556053768192963062015-09-30T13:47:00.000-05:002015-09-30T13:47:32.905-05:00Get Social This Month With a Free Book Excerpt From TMA<a href="http://2.bp.blogspot.com/-J2kl7euRLtE/VgwtTdweW7I/AAAAAAAACw0/f8pCdtF3MGE/s1600/Get-Social-Pub-Cover.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="200" src="http://2.bp.blogspot.com/-J2kl7euRLtE/VgwtTdweW7I/AAAAAAAACw0/f8pCdtF3MGE/s200/Get-Social-Pub-Cover.jpg" width="129" /></a>
<p>Looking for a road map to arrive at a stronger social media presence? This month, we’re offering help to get you more social savvy.</p>
<p>
During October, visit the TMA Education Center to download a free excerpt of <a href="http://www.texmed.org/getsocial" style="color: #954f72;"><i>Get Social: Put Your Practice on the Social Media Map</i></a><i> </i>by TMA’s Steve Levine and Debra Heater.<i> Get Social</i> explains how to use popular social media sites like Twitter, Facebook, YouTube, and others. The book offers handy tools and insights for physicians, medical students, and office staff interested in engaging with patients, and the public, on these platforms. You’ll also find advice and best practices for using social media responsibly and avoiding potential HIPAA pitfalls.</p>
<p><b><a href="http://www.texmed.org/GetSocialExcerpt" style="color: #954f72;">Download your free excerpt</a>. The free excerpt will be available through Oct. 31. </b></p>
<div class="blogger-post-footer">http://feeds.feedburner.com/bloggedarteries</div>Steve Levinehttp://www.blogger.com/profile/05032341081521706316noreply@blogger.com0