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Tuesday, October 28, 2014

TMA TO TASK FORCE: EBOLA OUTBREAK HIGHLIGHTS NEEDS IN COMMUNICATION AND TRAINING


With the good news of no new Ebola virus cases in Dallas and the apparent recovery of the two nurses who were infected, the nation turned its concern to the New York City physician who contracted the disease while working with Doctors Without Borders in Guinea. Here at home:
  •  More than 1,000 physicians and nurses tuned in to ask questions of Ebola experts in a Tele-Town Hall meeting convened by TMA and the Texas Nurses Association (listen to the recording). 
  •  TMA released a video, Why You're Not At All Very Likely to “Catch” Ebola, featuring Robert Haley, MD, director of the Division of Epidemiology in the Internal Medicine Department at The University of Texas Southwestern Medical Center in Dallas.
  • Chip Riggins, MD, the local health authority and executive director for the Williamson County and Cities Health District, testified on behalf of TMA before Gov. Rick Perry’s Texas Task Force on Infectious Disease, Preparedness, and Response. Dr. Riggins called for improvements in communications between practicing physicians and public health agencies; more graduate medical education slots in public health, prevention medicine, and epidemiology; and more attention paid to the needs of private practice physicians during an infectious disease outbreak.  

EARLY VOTING ENDS FRIDAY


This is the final week of early voting for the Nov. 4 elections. During early voting, which ends at 7 pm Friday, you may cast a ballot at any election site in your county. Data from last week showed early voting surges in some areas of the state, including Tarrant County, where TEXPAC is backing Libby Willis in a State Senate race against a blatantly antiphysician, antipatient candidate. TEXPAC recommends these outstanding candidates on your ballot. One way to remember to vote is to envision now a detailed plan of exactly where and when you will go to the ballot box. Make sure that plan includes encouraging your family, friends, staff, and patients to vote as well.

DR. KING CRISSCROSSING THE STATE FOR TMA


TMA President Austin King, MD, is keeping up his exhaustive travel schedule on behalf of Texas medicine. Between last week and this, Dr. King will have made public appearances in Houston, Lubbock, and Fort Worth, as well as numerous private meetings in between. Some highlights:
  • Tonight in Fort Worth, Dr. King is on the bill along with Congressman Michael Burgess, MD (R-Lewisville) and Texas Health and Human Services Executive Commissioner Kyle Janek, MD, at a health care town hall meeting hosted by State Rep. Matt Krause (R-Fort Worth).
  •  In Houston last week, he shared TMA’s Healthy Vision 2020 plans with the Executives Association of Houston and the Houston Chronicle editorial board.
  • Coming up in Lubbock, Dr. King has sessions planned with leaders, faculty, and students of the Texas Tech University Health Sciences Center; an editorial board meeting at the Lubbock Avalanche-Journal; and a lead role at the 2014 Health Care Symposium put on by the Texas Dispute Resolution System. 

MY LATEST IN FORBES.COM EXAMINES LOOMING PHYSICIAN SHORTAGE


The nation faces “drastic shortages” of physicians in many specialties — especially internal medicine and psychiatry — but our government doesn’t seem to be doing much about it. “Affordable Care Act Fails to Address Physician Shortages — Here’s How We Can Better Deal with This Challenge,” looks at a new tool, The FutureDocs Forecasting Tool, underwritten by The Physicians Foundation, that can help us figure out where to focus. “Unlike previous estimates of supply and demand, FutureDocs projects shortage and surplus by how well physician supply matches use of physician services; which in turn can be used to understand what type of care patients will need in the future and which geographies are experiencing greater imbalances in supply and distribution of physicians,” Physicians Foundation CEO Tim Norbeck and I wrote. “For example, while Rochester, Minnesota, the home of the Mayo Clinic, may be projected to have a surplus of specialists, Slidell, Louisiana is projected to have a significant shortage. What’s needed now is a scientific assessment of the supply and demand for health care services upon which to build the necessary health care infrastructure to ensure the health of the U.S. population.”

DON'T LET YOUR MEMBERSHIP LAPSE. RENEW TODAY!


Intrusion after intrusion is threatening your practice and the care of your patients as you know it. Fortunately, you can trust TMA and your county medical society to stand by you to address them. Your association advocates relentlessly in Austin and Washington to eliminate red tape and bureaucracy. But even as we work to deliver these legislative fixes, TMA provides first-class solutions to your practice headaches. The 2015 congressional and state legislative sessions are right around the corner. Renew today. The TMA Knowledge Center can answer your renewal questions at (800) 880-7955 or by email at knowledge@texmed.org.

REGISTER TODAY FOR TMA'S 2014 ADVOCACY RETREAT

Join TMA and state specialty societies in Austin Dec. 5-6 as we plan for the 2015 sessions of Congress and the Texas Legislature. Registration for the 2014 TMA Advocacy Retreat is open now.

Monday, October 20, 2014

HAVE EBOLA QUESTIONS? ANSWER YOUR PHONE TONIGHT


We received the good news this morning that the Texas Department of State Health Services (DSHS) has cleared Thomas Duncan’s first 43 Ebola contacts in Dallas after 21 days passed with no signs or symptoms. Local, state, and federal public health officials continue to monitor 120 people for the disease. Texans, however, remain concerned and worried about the outbreak. You can learn the latest about Texas’ Ebola response and how to protect you and your staff by participating in TMA’s Tele-Town Hall meeting tonight. TMA physician experts and Department of State Health Services’ leaders will be on hand to answer your questions from 7 to 8 pm. TMA and the Texas Nursing Association are cohosting the meeting. We will call you directly at your home phone number. All you need to do is pick up the phone and stay on the line. If you don’t want to participate, just hang up. If you can’t make the call and want to hear what was discussed, please go to TMA’s Ebola Virus Resource Center. A recording of the meeting will be posted Tuesday. This event is the latest in the series of TMA activities to keep Texas physicians and the public informed about the science of the Dallas Ebola crisis. They include: 
  • Protect Yourself From the Ebola Virus — an easy-to-understand patient flyer, in English and in Spanish, that we developed in conjunction with the Dallas County Medical Society (DCMS).
  • What if Someone Walks Into My Office With Ebola? — science-based guidelines to prepare your practice and protect your staff and patients if someone presents with Ebola symptoms.
  • “Facts, Not Fear” — an outstanding town hall meeting that DCMS hosted with WFAA-TV. Watch the replay.
  •  TMA’s Ebola Virus Resource Center — The U.S. Centers for Disease Control and Prevention (CDC), DSHS, U.S. Department of Health and Human Services (HHS), and Dallas County Health and Human Services have issued numerous bulletins, guidelines, and other materials to help you respond to the Ebola outbreak. We organize them for your ease of use.

VOTE EARLY, STARTING TODAY


Early voting in the Nov. 4 general election starts today and runs through Friday, Oct. 31. Here’s a few reasons for you to head to the polls in this nonpresidential-election year:
  • One candidate for the Texas Senate says physicians want to “administer life-ending procedures” to our patients! Really.
  • Other, more medicine-friendly, candidates have pledged to help us cut government regulations on our practices, boost public health, increase funding for graduate medical education, and protect our tort reforms.
TEXPAC recommends these outstanding candidates on your ballot. In most counties, you may cast an early ballot at any election site. On Nov. 4, you may vote only at your home precinct.

DR. KING PLANS MESSAGING STRATEGY FOR MEDICINE


Texas physicians and TMA are under an unprecedented attack. Candidates and special interest groups on both the left and the right, leveraging social media, are striving to undermine your authority and the patient-physician relationship. TMA President Austin King, MD, met with senior TMA staff to work on our ongoing strategy to counter the assault. It’s terribly important that we succeed, not only to protect your professional dignity as physicians but also to ensure that TMA can continue to win big victories for medicine at the Capitol. As we move forward, we will be asking for you — medicine’s leaders — to help us get the word out about our science-based dedication to patients and health. Today, though, I’m asking you to help us develop a slogan or tagline for this campaign. What does medicine really stand for? Send me your ideas. 

ON MY VISIT TO THE GREEK CAPITOL OF TEXAS


At the invitation of TMA Board of Trustees member Doug Curran, MD, chief lobbyist Darren Whitehurst and I travelled to Athens to meet with the Henderson County Medical Society. We reviewed Healthy Vision 2020 and our 2015 legislative priorities. If you want Dr. King or a member of the TMA staff to speak to your county medical society, contact our Ambassador Program.

SURVEY FINDS CLINICAL AUTONOMY THREATENED


Only 31 percent of U.S. physicians — and slightly fewer in Texas — say they are free to make what they consider to be the best decisions for their patients, according to The Physicians Foundation’s 2014 Survey of America’s Physicians. About 53 percent in both Texas and nationwide said they have some limitations in their clinical autonomy. But nearly 18 percent of Texas physicians and 15 percent of those across the country said, “My decisions often are compromised.” TMA and The Physicians Foundation are working to educate the public and policymakers on both the causes and the implications of this troubling trend so that we can begin to reverse it.

HARD HATS HITS HELMET RECORD IN OCTOBER

Thanks to your collective efforts, TMA’s Hard Hats for Little Heads is putting more than 6,000 helmets on Texas children in October. That’s the most helmets we’ve ever given in one month. TMA declared October as Hard Hats for Little Heads Month to mark the program’s 20th birthday and to celebrate 20 years of keeping kids safe.

Tuesday, October 14, 2014

SECOND EBOLA CASE SHOCKS DALLAS


Four days after the death of the first patient diagnosed with Ebola in the United States, someone who helped to care for him in a Dallas hospital has apparently become the first person to acquire the disease in this country. The New York Times is reporting that the person is a female nurse at the hospital. U.S. Centers for Disease Control and Prevention Director Tom Frieden, MD, said the nurse wore the appropriate protective clothing and equipment while caring for the first patient, but she became infected due to a “breach of protocol.” None of the 48 original known contacts of the first patient has shown any symptoms, Texas Health Commissioner David Lakey, MD, said on Sunday. Dallas County Medical Society (DCMS) President Todd Pollock, MD, and John Carlo, MD, chair of the DCMS Community Emergency Response Committee, urged calm. “DCMS physicians have long been trusted community leaders and have a long history of responding to many public health issues, from organizing Dallas’ participation as a field test site for the Salk polio vaccine in 1945, to leading the county’s response to the West Nile Virus epidemic in 2012,” they said in a Sunday night email to Dallas doctors. “Physicians are one of society’s most trusted voices, so it is imperative that we speak up and contribute to the conversation using factual information based on medical science.” In that vein, we offer the following resources: 

THE WORST ATTACK YET ON MEDICINE


Politics can be an ugly, dirty business. A campaign mailer from a Texas Senate candidate in Fort Worth fits that bill, assassinating the character of physicians all across the country. In not one, but two, mail pieces Senate District 10 candidate Konni Burton says she “will fight to protect the elderly and disabled patients from doctors who want to administer life-ending procedures.” TEXPAC has endorsed Libby Willis — Burton’s opponent — and is working with the Tarrant County Medical Society (TCMS) to turn out the vote for Ms. Willis. TEXPAC District Chair Robert Rogers, MD, who is hosting a fundraiser for Ms. Willis at his home tonight, sent a letter to all TCMS member physicians. “One candidate who wants to be our next state senator from Tarrant County says physicians want to murder our patients,” Dr. Rogers wrote. “This is an outrage! It’s character assassination of an entire profession. She must be stopped, and we have the power to stop her.”

DR. VARMA APPOINTED TO TEXAS MEDICAL BOARD


Gov. Rick Perry appointed Lubbock pediatrician Surendra Varma, MD — a great leader of organized medicine in our state — to the Texas Medical Board. Dr. Varma is associate dean of Graduate Medical Education and Resident Affairs at Texas Tech University Health Sciences Center-Lubbock. A past president of the Lubbock-Crosby-Garza County Medical Society, Dr. Varma is the 2014 recipient of TMA’s Platinum Award for Excellence in Academic Medicine.

NEW TMA NEWS SERVICE BEGINS WEDNESDAY


Watch your inbox at around 7:30 am each weekday beginning Wednesday for an email from “TMA Daily Headlines.” Inside will be our newest free member service. From health care news in Congress and Texas Legislature to news regarding practice management, public health, and medical education, you can count on TMA Daily Headlines for the comprehensive coverage you need to prepare for the day ahead.

MAKE PLANS FOR TMA 2014 ADVOCACY RETREAT

Come to Austin Dec. 5-6 to help prepare TMA and state specialty societies for the thorny issues that await in the 2015 Texas Legislature and U.S. Congress. Registration is now open!

Wednesday, October 8, 2014

EBOLA CONTACT TRACING IS CORE PUBLIC HEALTH WORK


Although our fragmented public health system still needs some significant repairs, the response has been on target since the diagnosis of Thomas Duncan of Dallas as the nation’s first Ebola patient. As of 11 am today, public health physicians had confirmed 10 persons definitely had been exposed to Ebola through Mr. Duncan, and 38 possibly had been exposed. All 48 of those people are being monitored daily throughout the 21-day incubation period of Ebola. “Our function here is to monitor every contact and every possible contact,” Texas Health Commissioner David Lakey, MD, said in a briefing yesterday afternoon. “The good news is that we have had no more cases, and no one has reported any symptoms.” I am particularly proud of Dallas County Medical Society physicians in working with state and national public health officials to contain this outbreak. Public health specialists John Carlo, MD, and Robert Haley, MD, have done an outstanding job explaining this frightful disease to the public through the news media. On Friday, TMA, Dr. Lakey’s office, and the Texas Hospital Association (THA) conducted an Ebola briefing for legislative staffers at the state Capitol. TMA will send a special issue of our Action newsletter later today with a comprehensive list of resources physicians need to talk to their patients about Ebola and assess possible cases.

SUNSET REPORT CALLS OUT MEDICAID FRAUD CONTROL TACTIC


The state’s use of freezing payments to providers suspected of possible Medicaid fraud “has gone beyond the law’s intent,” according to a 225-page report on the Texas Health and Human Services Commission (HHSC) issued late Friday by the Texas Sunset Advisory Commission. The report includes sweeping recommendations for the vast agency, including further consolidation of the state’s health activities. The Sunset Commission described the HHSC Office of Inspector General (OIG) as an agency with poorly trained staff and little accountability or transparency. Sunset devoted an entire chapter of its report to OIG’s improper use of payment holds. “Despite the intended serious nature of payment holds, OIG uses payment holds as a negotiation tactic or bargaining tool, even for cases that do not pose significant financial risks to the state,” Sunset reported. “[Payment hold] hearings provide for excessive process and create undue burdens on providers as compared to cases presenting more serious risks to the state and public.” Sunset Commission recommendations serve as a starting point for deliberations by the 2015 legislature.

COALITION OF STATE MEDICAL SOCIETIES: PASS SGR FIX, AND FUNDING, BY JAN. 1


The Coalition of State Medical Societies wrote congressional leaders, exhorting them to pass Medicare Sustainable Growth Rate (SGR) payment reform by Jan. 1, 2015, and to find the funding needed to ensure its passage. “We cannot urge you strongly enough to engage now in the pursuit of a long-term funding solution,” the nine medical societies wrote. “We ask for you to remain open to an array of potential funding sources, some that you may have opposed in the past. But please remember, these vital funds will accomplish a historic change in America’s health care system.”

TMA, HOSPITALS TEAM UP FOR MEDICAL STAFF LEADER TRAINING


The fall session of the Orientation for Presidents of Hospital Medical Staffs, cosponsored by TMA and THA, is Oct. 24-25 in Austin. Hospital medical staff leadership are invited to learn about quality reporting requirements, error and risk management, a 2015 legislative update, and more.

FEDS HOLD $75 MILLION FROM TEXAS HOSPITALS ON MEDICAID WAIVER QUESTION


Questions about the source of the dollars some Texas hospital districts are using to obtain matching funds from the Centers for Medicare & Medicaid Services (CMS) under the Section 1115 Medicaid waiver program have led CMS to withhold $75 million in payments for uncompensated care to hospitals in the Dallas, Austin, and Corpus Christi areas. “It appears that the [Texas money] may be derived from funds that the government entity previously would have spent on providing the services that are now being provided/funded by the private entity and/or direct payments made to the governmental entity from private entities,” CMS officials wrote to state Medicaid Director Kay Ghahremani. CMS will defer further payments pending its investigation.

MY LATEST ON FORBES.COM: PHYSICIAN MORALE STILL LOW, BUT IMPROVING

The newly released Physicians Foundation survey of American physicians shows some bad news — but not as bad as our 2012 survey revealed, I explain in my latest post on Forbes.com. The survey of 20,000 U.S. physicians reports that 56 percent describe their morale as negative. But optimism has increased by more than 12 percentage points — especially among younger, employed physicians — since 2012. “Health care has become over-regulated, overly bureaucratic and overly administered by non-physicians,” Physicians Foundation CEO Tim Norbeck and I wrote. “This has created an increasingly dispirited cadre of physicians being forced to implement ill-conceived rules and regulations that do not benefit the patient and unnecessarily increase the cost of care.”