Friday, March 24, 2017

Matthew Ferrara letter

Hello everyone --

Over the last few years, HHSC has been increasingly focused on Alternative Payment  Models (APM). APMs (often called value based purchasing (VBP)), refer to healthcare payment models that move away from simple fee for service to models that create linkages between the healthcare payment and measures of quality and/or efficiency (i.e. "value"). Through the Managed Care Organization's contract, HHSC is strengthening its requirements for MCOs to expand APMs with providers.

Because APM  is a paradigm shift, we seek your feedback on a short survey. If you are with a Provider or MCO Association, please forward this email to your association members. If you are an RHP Anchor, please forward to DSRIP Providers (one response from each DSRIP provider would be great). The more feedback we receive, the more it helps HHSC understand APMs from your perspectives.  HHSC will be setting up a meeting with MCOs and providers to discuss this issue, and the information obtained from the survey will help guide the discussion.

This is the web-link into the survey:
Value-Based Payment (VBP) Implementation Survey
Web survey powered by Create your own online survey now with SurveyMonkey's expert certified FREE templates.

Thanks in advance for your participation and for your commitment to Texans.

Matthew Ferrara
Director, Quality Oversight
Quality and Program Improvement
Medicaid and CHIP Services

TMLT Seminar April 19

TMA Ethics Seminar

Thursday, March 16, 2017


NMA Conference April 7-9, 2017

Register Today!

You Are Invited to the 
NMA Region V Conference
Join us for learning and networking in San Antonio, Texas. The National Medical Association Region V Conference is one of the most significant gatherings of thought leaders and practitioners today in the field of healthcare. NMA Region V will be showcasing its rich history and commitment to access, innovation, and engagement. The conference will feature topics aligned with NMA Region V's goal of eradicating health disparities, improving community health, and preparing physicians and practitioners to successfully navigate the ever changing healthcare system. 
Eleanor Lisbon, MD
NMA Region V, Chair

Speaker Highlights 
Violence & Medicine

Dr. Lawson is the Associate Dean for Health Disparities at the Dell Medical School and Director of Community Health Programs and a Professor at Huston-Tillotson University, where he leads the Sandra Joy Anderson Community Health and Wellness Center. He is also UT Austin's institutional representative for the Health Disparities Education, Awareness, Research and Training (HDEART) Consortium. Dr. Lawson will lead a discussion on violence and medicine specifically the impact of adverse experiences and the impact on chronic diseases, mental illnesses and early death. 

Speaker Highlights
The Dash Difference

Proven to lower blood pressure, cholesterol levels and improve heart health, DASH has also been named the No. 1 diet by
US News & World Report seven years in a row.  Join us for an interactive, informative and engaging cooking demonstration with DASH expert Cindy Kleckner, RDN, LD, FAND.  Friday, April 7th, conference dinner program at Casa Hernan in San Antonio. 

Hotel Accommodations 
306 West Market Street,
San Antonio, Texas 78205
210.298.8058 | Hotel Contessa

Room Rate: $229 (Until March 8, 2017)
Code: NMA Region V

Place article copy here. Be sure to make the articles short and concise a people ted not to read muore thparagraph

Exhibitors & Sponsorship Opportunities 
For more information on how to be become a partner of the 2017 NMA Region V Conference through exhibiting or sponsorship, contact Derek Lewis II at

For more information about the conference contact Derek Lewis II, at To register the click link below. Follow us on twitter at #nmaregionvsanantonio 

National Medical Association Region V, 8403 Colesville, Silver Spring, MD 20910

Letter in support of John R. Holcomb for TMA Board of Trustees

March 14, 2017
Dear colleague:

BCMS proudly supports John R. Holcomb, MD for TMA Board of Trustees

The Bexar County Medical Society and the Bexar Delegation to the Texas Medical Association announce the candidacy of John R. Holcomb, MD, for TMA Board of Trustees.

Dr. Holcomb has been a member of the Bexar County Medical Society (BCMS) and Texas Medical Association (TMA) since 1982, the year he began private practice in Pulmonary/Critical Care in San Antonio. A graduate of Texas A&M University and Southwestern Medical School, Dr. Holcomb trained in Internal Medicine and Pulmonary Medicine/Critical Care at the University of California Hospitals and the University of Texas Health Science Center San Antonio. In addition, Dr. Holcomb is a retired U.S. Army Colonel, having served with 1st Special Forces Group, Academy of Health Sciences, Brooke Army Medical Center, 114th Evacuation Hospital, 90th Army Reserve Command, and U.S. Army Hospital, Kosovo.

An active member in organized medicine, Dr. Holcomb served as Bexar County Medical Society President in 1993. He has previously served on numerous committees at BCMS and currently sits on the Society’s Legislative and Socioeconomics Committee. Dr. Holcomb has served on the BCMS Board of Directors for 3 years and presently holds the position of Treasurer. He has been a delegate to the TMA since 2007. Dr. Holcomb has had extensive service at the TMA level, serving 9 years on the Council on Socioeconomics and 15 years as Chair of the Select Committee on Medicaid, CHIP and Access to Care. He has also held numerous ad hoc committee assignments and has frequently testified before the Legislature on behalf of TMA and affiliate organizations.

Dr. Holcomb has also previously held board assignments in the community, including the Texas Society of Internal Medicine, Texas Hospital Association, Methodist Healthcare System, and Methodist Hospital Physician Alliance.
Presently, he serves on the Board of Texas Medical Liability Trust and as Chair of BexarPac, a political action committee with a focus on judicial races in Bexar County.

We respectfully request your support of Dr. Holcomb for TMA Board of Trustees at TexMed in May.

Leah H. Jacobson, MD
BCMS President

Jayesh Shah, MD
BCMS Past President

William (Bill) Hinchey, MD
TMA Past President

Jesse Moss Jr., MD
BCMS Past President

James L. (Jim) Humphreys, MD
TMA Council on Legislation

Gerald Greenfield, MD
BCMS Board Secretary
Alex Kenton, MD
Chair, BCMS Legislative Committee

K. Ashok Kumar, MD
TMA Board of Councilors

David N. Henkes, MD
TMA Board of Trustees

Advocating for physicians, patients, and our community since 1853.
PO Box 781145 • Zip 78278 • 4334 N Loop 1604 W, Ste 200 • San Antonio, TX 78249-3485 • (210) 301-4391 •

Tuesday, March 14, 2017

Texas Wins Tort Border Battle

The New Mexico Supreme Court ruled Monday in favor of a Lubbock physician entangled in a question of whether Texas or New Mexico law should apply in a liability case involving care that was provided in Texas but for a New Mexico patient.

The decision is a victory for TMA, West Texas physicians, and organized medicine in Texas and New Mexico. Although the specifics of the verdict applied to a Texas physician who was employed by a government institution, TMA’s General Counsel opines that the ruling should be helpful to all Texas physicians treating patients from New Mexico traveling to Texas. This is because the Texas 2003 medical liability reforms are generally more favorable that those in place in other states.

The case, Montano v. Frezza, involved Kimberly MontaƱo, a New Mexico resident, who sought surgery in 2004 from Eldo Frezza, MD, a Lubbock bariatric surgeon and professor at Texas Tech University Health Sciences Center. The issue was over which state’s medical liability laws would prevail in a case in which a New Mexico resident received care in Texas but claimed complications after returning to New Mexico. For additional details on the case, see "Border Battle," from the November 2015 issue of Texas Medicine.

Dr. Frezza told TMA he was exhausted by the fight but elated by the ruling.

“The lawyers have to understand how their activity is affecting patients, not just physicians,” he said. “This lawsuit was affecting tons of patients in eastern New Mexico. A lot of good people, working people, people who pay taxes are affected by the blindness of our society.”

Howard Marcus, MD, chair of the Texas Alliance for Patient Access (TAPA), which was one of several Texas groups that filed briefs in the case, also hailed the decision.

“Yet again, TAPA, working with its member organizations, such as the TMA and county medical societies, has prevailed in a crucial decision that promotes access to care across the Texas-New Mexico state line,” Dr. Marcus said. “Common sense and logic have prevailed.” 

The Texas Medical Liability Trust (TMLT), University of Texas System, and New Mexico Medical Society also filed briefs in support of Dr. Frezza’s position.

The 4-1 decision “only considered the issue of comity – that is respecting the sovereignty of sister states,” said Jill McClain, TMLT executive vice president for government relations. The court’s analysis of that issue focused heavily on data that TAPA, TMA, TMLT, the American Medical Association, several county medical societies, and others provided showing how much residents of eastern New Mexico depend on West Texas physicians and hospitals for care.

“Access to cross-border health care for individuals living in rural parts of New Mexico is an additional consideration that tempers New Mexico’s interest in applying its law to this case,” the court majority wrote. “We do not consider it overly speculative to conclude that extending comity to Texas in this case will positively serve New Mexico’s public policy interests by encouraging the continuing cooperation of Texas and New Mexico in maintaining cross-border care networks.”

Although the court ruled in favor of the Dr. Frezza in this instance, TMA suggests physicians continue to avail themselves of the law New Mexico enacted last year allowing them to obtain a signed agreement from New Mexico patients stating that should they wish to file a lawsuit they will do so in Texas court. To help physicians take advantage of the law's protections, TAPA developed two forms, one for emergency treatment and one for voluntary treatment. You can download the emergency treatment and voluntary treatment forms (English or Spanish-and-English) from the TMA website.

In consultation with an attorney, TMA suggests physicians who treat New Mexico patients or patients living in other states consider adopting this language in the practice forms patients sign. 

Monday, March 13, 2017

Scope Code Blue

Drop date: Monday, March 13, 2017
Audience: All physician members in Texas with email who did not open Feb. 28 alert
Subject line: An Onslaught of Bad Scope Bills. Stop Them
Template: TMA 

Dear Dr. [LAST]

Please act now to block two bad bills that would allow people with far less education, skills, and training to do what you do.

Remember the long hours you spent studying in medical school, the permanent stench of formaldehyde on your clothes and body, the months of reading weighty textbooks and traipsing behind your physician mentors during your clinical clerkships?

Remember the interminable days and nights and weekends during your residency when you learned how to actually take care of a patient, with increasing degrees of autonomy?

As physicians, our education, skills, and training are more than just badges of honor. They’ve earned for us the privilege of practicing medicine, of having patients place their health in our hands with the reasonable expectation that we will help them heal or mend safely.

Some members of the Texas Legislature, however, don’t quite see it that way. They don’t appreciate the work we’ve put in to obtain that privilege. They think it’s safe to allow lesser-trained practitioners to play doctor.

In fact, we’ve seen an onslaught of bad bills that would expand those practitioners’ scope of practice. More than 40 such proposals have been filed here in Austin this year. Some would grant advanced practice registered nurses (APRNs) independent prescribing. Others would allow direct access to physical therapists without a physician diagnosis and referral, allow psychologists to prescribe, and give pharmacists diagnosis and prescribing authority. And there are many more questionable expansions.

We need to stop two very bad bills right now. Please contact your state lawmakers, Sen. <FIRST> <LAST> and Rep. <FIRST> <LAST>, today. Let them know what those years of learning mean for your patients. Tell them you oppose these bills and ask them to help the Texas Medical Association stop them: House Bill 1415 by Rep. Stephanie Klick (R-Fort Worth)/Senate Bill 681 by Sen. Kelly Hancock (R-North Richland Hills) would grant APRNs full, independent practice and prescribing authority.

You can call Senator <LAST> and Representative <LAST> at their Capitol offices:

·         Senator <LAST>: <CAP PHONE>
·         Representative <LAST>: <CAP PHONE>

Or you can use the TMA Grassroots Action Center[SL1]  to quickly and easily send them both an email.

Please call or write today. The nurses have been busy drumming up support for these bills by dramatically downplaying the differences in our education, skills, and training — and what that means to our patients.

Remember this simple message: We strongly support team-based care, but if you want to practice medicine, go to medical school.


Don R. Read, MD
Texas Medical Association


·         I am a physician who lives in your district. I am writing to express my strong opposition to two bills that would allow nonphysicians to engage in the practice of medicine. Such a change would not expand access to health care; it would increase the cost of health care, and it would not be safe for the people of Texas.
·         Please do not support House Bill 1415 by Klick/Senate Bill 681 by Hancock, which would grant advanced practice registered nurses (APRNs) full, independent practice and prescribing authority.
·         I oppose independent practice for APRNs without collaboration with a physician. To protect patient safety, diagnoses and prescriptive authority must remain the purview of medicine.
·         Expanding APRNs’ scope of practice will not increase access to care in rural Texas. In states that do and do not allow APRNs independent practice, the vast majority of them practice exactly where most physicians practice — in the metropolitan areas.
·         Expanding APRNs’ scope of practice will increase the cost of care. Research comparing APRNs with physicians found a 41-percent increase in hospitalizations and a 25-percent increase in specialty visits among patients treated in the same setting by APRNs.
·         Please compare the number of patient-care hours required in training. Physicians like me receive 12,000 to 16,000 hours of training through medical school and residency. APRNs, however, have just 500 to 720 hours of patient-care hours in their training.
·         Physicians and nurses worked together in 2013 to devise a landmark state law that improved collaboration and supervision. I support improvements to the collaboration process and exploring ways to improve access to care, especially in underserved areas.
·         Physicians strongly support team-based care, but if you want to practice medicine, go to medical school. Thank you for your consideration.

 [SL1]Deb – different link

Wednesday, March 8, 2017

Telehealth drives up healthcare costs

Telehealth drives up healthcare utilization and spending
By Maria Castellucci  | March 7, 2017
Modern Medicine

Telehealth, which is frequently touted as an effective strategy to decrease healthcare spending, may actually be driving up costs, according to a new study by the RAND Corp.

The report, published Monday in the journal Health Affairs, found that although telehealth appointments are cheaper than in-person and emergency room visits, the online and virtual resources encourage vast new utilization, ultimately driving up healthcare spending.

The findings are a surprise wake-up call as employers increasingly look to offer telehealth services to their workers. About 90% of large employers said they would offer telehealth services as part of their employee health plans in 2017, according to a 2016 survey from the National Business Group on Health.

The study's researchers used 2011-13 claims data from the California Public Employees' Retirement System to dive into telehealth costs. The authors compared the cost and use of telehealth visits and in-person visits for patients seeking treatment for acute respiratory infections, one of the most comment conditions treated via telehealth services.

The researchers found that only 12% of direct-to-consumer telehealth visits replaced a visit to another provider.

The convenience of telemedicine is encouraging people to seek care when they normally wouldn't, said Scott Ashwood, lead author of the report and associate policy researcher at RAND Corp. “You don't even have to go anywhere … you just have to pick up the phone.”

An individual may be less inclined to go see their primary-care doctor or visit the ER if they have the common cold or a high fever. But the easy access and low cost of telemedicine may motivate people to seek a clinical consultation, Ashwood said.

On average, a telemedicine appointment costs about $79 compared to $146 for a doctor's visit and $1,734 for an ER visit, the study found.

RAND Corp. found a similar trend taking place among retail clinics. A study in November 2016 found ERs near retail clinics didn't experience a reduction of visits from patients with low-acuity illnesses.

To discourage telemedicine overutilization, the authors suggested increasing patient cost-sharing for the consultations. This could encourage people to consider more critically what conditions they will seek care for, Ashwood said. “If I have to pay more out of pocket to pick up the phone, maybe I don't,” he said.

The authors also suggested health plans reach out to patients who frequently use the ER and encourage them to use telemedicine services instead. Ashwood said patients with chronic conditions that frequently use the ER for care will effectively decrease spending if they use telemedicine instead.

“We are seeing patients responding (to telemedicine) so there is a benefit to respond to certain populations,” Ashwood said.