Dear Texas AAPS Members and Friends,

The Texas Sunset Advisory Commission will soon be voting on its recommendations to the legislature as it considers reauthorizing the Texas Medical Board in the 2019 session.

Several helpful recommendations have been made by members of the Commission, some of which were advocated by the Texas chapter of AAPS. We are hopeful that the Commission will approve these changes to benefit the good doctors of Texas and their patients.

Please let your voice be heard by sending a message to the Commission encouraging them to adopt helpful improvements that have been recommended.

This needs to be done before Thursday! The Commission meets to consider these changes on Thursday, May 24.

The following helpful recommended proposals should be adopted:

1. The right to Trial de Novo in appeals of medical board discipline. Current law restrains the court’s review of facts as decided by the TMB.
2. Texas must not adopt the Interstate Medical Licensure Compact. In lieu of joining the Interstate Medical Licensure Compact, consider adoption of a Texas-governed expedited licensing process for qualified out of-state physicians.
3. Allow expanded access to expert reviewer reports for informal settlement conferences.
4. Additional flexibility in nondisciplinary actions for less serious violations.
5. Audit requirements for the Texas Physician Health Program and rules regarding its interactions with the Board.

The full list of recommendations can be found at this link: Sunset Decision Meeting Material (pg. 12) https://www.sunset.texas.gov/public/uploads/u97/Decision%20Meeting%20Materials_May.pdf

Please send a simple statement to the Commission members asking for the items listed above, and any others you may want to add.

Below is a sample letter:

Dear Chair Birdwell, Vice Chair Paddie and Members of the Sunset Commission,

Thank you for your dedication to seeking improvements to the Texas Medical Board that will benefit Texas patients and their doctors.

We ask you to approve the following recommended reforms under consideration at the May 24 decision meeting:

1) The right to trial de novo in appeals of medical board discipline. Current law restrains the court’s review of facts as decided by the TMB.

2) Texas must not adopt the Interstate Medical Licensure Compact. In lieu of joining the flawed Compact, consider adoption of a Texas-governed expedited licensing process for out of-state physicians.

3) Allow expanded access to expert reviewer reports for informal settlement conferences.

4) Additional flexibility in nondisciplinary actions for less serious violations.

5) Audit requirements for the Texas Physician Health Program and rules regarding its interactions with the Board.

Thank you for considering approval of the above needed reforms.

Sincerely,

For some email apps, clicking here will launch a new message with the above text and commission email addresses filled in.

If the link doesn’t work for you, here is a list of addresses you can copy and paste into a new email message:

Brian.Birdwell@senate.texas.gov,dawn.buckingham@senate.texas.gov,bob.hall@senate.texas.gov,robert.nichols@senate.texas.gov,kirk.watson@senate.texas.gov,Chris.Paddie@house.state.tx.us,dan.flynn@house.state.tx.us,stan.lambert@house.texas.gov,Poncho.Nevarez@house.texas.gov,senfronia.thompson@house.texas.gov,sunset@sunset.texas.gov

If you have time to make a few phone calls, to quickly access phone numbers, click here and then on the names of commission members (particularly members representing your district).

Thank you for speaking out! Your input does make a difference.

Our Texas chapter meeting will be May 19th in San Antonio. We look forward to seeing you there!

Details:

When: Saturday, May 19, 2018 from 2pm to 8pm

Where: Hilton Homewood Suites, 125 North Loop 1604 W, San Antonio, TX 78232

(We have a limited number of guest rooms available. Let us know if you need a hotel room for Saturday night by replying to this email or calling AAPS Business Manager Jeremy Snavely – 520-270-0761.)

Cost: $50 AAPS members, $75 non-members, $25 additional guest, med student and residents FREE.

Includes dinner and up to 4 hours of Category I CME.

2pm to 2:30pm
Registration / Meet & Greet

Panel I: Restoring Freedom to American Medicine

2:30pm to 2:40pm
Welcome/Intro to Panel I
Sheila Page, DO
Chapter President

2:40pm to 3:00pm
Update on TX Legislation Impacting Doctors & Patients
Rep. Greg Bonnen, MD
Texas House of Representatives, District 44

3:00pm to 3:30pm
The Big Myth of Health Care.
Kevin Wacasey, MD
http://healthcareonomics.com/

3:30pm to 4:00 pm
The Dangers of the Administrative State, and how the “Opiate Crisis” Exemplifies those Problems.
John Dale Dunn, MD, JD

4:00pm to 4:45pm
Keynote: AAPS has the Cure for Sick Healthcare.
Deane Waldman, MD, MBA
Texas Public Policy Foundation

4:45pm to 5:00pm Q & A with Panel I

5:00pm to 5:15pm BREAK

5:15pm to 5:30pm Business Meeting and Election of Officers*

5:30pm DINNER & special video message

6:00pm to 6:30pm
Protecting Physician Rights of Conscience.
Darren Meyer, MD
Psychiatry, McKinney, TX
Panel II: Reducing Rx Costs

6:30pm to 6:40pm
Intro to Panel II
Sheila Page, DO
Chapter President

6:40pm to 7:10pm
PBMs: Profit Before Patients.
Ray Page DO, PhD
Oncology/Hematology, Weatherford, TX

7:10pm to 7:40pm
Why We Need In-Office Dispense
and What We Must Do to Make it Legal in Texas.
Kris Held, MD, Ophthalmology, San Antonio, TX
7:40pm to 8pm Q&A with Panel II

8pm Adjourn

*Note about business meeting: We will have a brief business meeting to elect officers and board members. Please notify us at president@texasaaps.org if you have an interest in being a part of leadership in this organization. Our nominating committee will be searching for strong leaders to represent Texas physicians.

The positions up for election are President, President-elect, Secretary, Treasurer, and 2 positions on the Board of Directors, ( 2  two-year terms).

More about our featured speaker: 

Deane Waldman MD MBA is a retired pediatric cardiologist and system theorist analyst for American healthcare. He brings 37 years of clinical experience plus the business and administrative experience as Chief of Pediatric Cardiology at University of Chicago to the position of Director of the Center for Health Care Policy at the Texas Public Policy Foundation. He is also the Consumer Advocate member on the Board of Directors of the New Mexico Health Insurance Exchange. His background and academic training include Yale, Chicago Medical School, Mayo Clinic, Northwestern, Harvard and Anderson Management Schools. He has authored over 150 academic medical publications and more than 250 lay articles on both management and strategy in healthcare.

“Dr. Deane,” as he is commonly known, is the author of award-winning print books including The Cancer in the American Healthcare System and the eBook series titled, Restoring Care to American Healthcare. We will have copies available at the event but you can use the links above to get your copies in advance. For those who prefer brick and mortar, they are also available at the BookPeople in Austin.

Dear AAPS members and friends,

In legislation passed this summer, the Texas legislature continued the medical board for only two years. This short extension means we have another opportunity NOW to pursue reform to improve the board’s interactions with the physicians under its regulation for the benefit of the patients they treat.

Despite past success in achieving changes, continued reforms are indeed needed. Just last week, for example, AAPS submitted an amicus brief with the U.S. Fifth Circuit asking the court to hold the TMB accountable for seizing patient records without a warrant in violation of the due process clause protections of the Fourth Amendment. In another case, the board continues to improperly restrict a physician whistleblower’s license even after an administrative law judge cleared the doctor of wrongdoing in an 80-page ruling.

Please help us and your colleagues by suggesting other needed reforms.

The Sunset Commission suggests submitting comments by October 27, but don’t worry if you can’t meet this cutoff, please simply submit your ideas as soon as possible. In addition, there will be other opportunities in the future to give input.

One needed change we are suggesting to the Sunset Commission, and you might suggest too, is the need for trial de novo review of medical board discipline.  Read more about this proposed change here: https://goo.gl/7jBxHF

There are a few easy ways to comment:

1) Email your comments to sunset@sunset.texas.gov

2) Fax them to 512/463-0705

3) By mail to:
Sunset Advisory Commission
P.O. Box 13066
Austin, Texas  78711

4) Or use the online form here: https://www.sunset.texas.gov/input-form

If you submit comments please forward a copy to us at president@texasaaps.org.

Thank you for your consideration of this important opportunity.

~TxAAPS
“Patients First”

Dear AAPS Texas Chapter Members and Friends:

It is a privilege to serve the doctors of TxAAPS.  I want to share with you a few important links to information on relief efforts for flood victims and encourage all to find ways to help the many people who are in need.  Also, I am including a summary of some of the work the TxAAPS board did earlier this year.

1. Disaster Recovery

In the wake of the hurricane disaster in the Houston area, we have much to be thankful for, and there is so much we can offer to those who will be in need for potentially months to come. The medical center in Houston has been able to respond quickly and had the preparation and resources to be operational in a short time frame.

There are many displaced people, however, and doctors and staff are among them. The medical clinics will take time to rebuild.  Patients will still need care and many will not have transportation for a while.

While most of us are capable of clearing debris and donating supplies, we may also be able to offer volunteer medical care in areas that are more seriously affected by the hurricane damage and flooding, and in the areas where displaced persons have been concentrated in shelters.

There are volunteer organizations in place already who have stand-by lists of medical professionals who have volunteered to help.  Some links to these organizations and their efforts are here:

• Texas Volunteer Organizations Active in Disaster (TX VOAD) http://txvoad.communityos.org/cms/node/104
• OneStar Foundation: https://onestarfoundation.org/
• HHS Activities: the official HHS release with everything the agency is doing currently: https://www.hhs.gov/about/news/2017/08/28/hhs-establishing-medical-shelter-to-aid-those-affected-by-hurricane-harvey.html

We need to look to long term help for patients who may not soon be able to return to normalcy. People whose homes were damaged may not have the financial reserves to pay for the high deductibles imposed on them by insurances. The exceptionally high cost of medication will add further to the strain on limited resources.

One of the potential solutions we could offer is to send mobile medical units to areas with high needs.  They can be used by local teams of medical professionals or by volunteer teams.   Crisis pregnancy units equipped with sonogram capabilities would offer help for women and children. Many have offered individualized services, and we can expect Texas doctors to reach out to the people who need care during this crisis.

2. Legislative Update

Other important issues that have been the focus of our board include the contentious issue of MOC mandates.  The SB1148 victory in the regular session was even more remarkable in view of the difficulty in the Texas legislature of passing other more high-profile legislation.

While the bill takes effect January 1, 2018, proactive physicians are already taking matters into their own hands. A unanimous vote in favor of removing MOC requirements occurred June 27 at Memorial Hermann Southeast and other hospitals in the system will hopefully be soon taking a similar vote.

During the recent special legislative session in Austin, we obtained the support of a coalition of over 64 groups to send a position letter to inform the legislators of the problems with the Interstate Medical Licensure Compact (IMLC). Our goal was to raise awareness and make sure the IMLC didn’t resurface in the TMB Sunset bill.

In addition, the Texas AAPS Board members co-signed a rebuttal to a JAMAarticle that was critical of Texas’s SB1148.

3.  Chapter Meeting, Elections, and Other Events

Below are some upcoming events that you may be interested in—we hope you join us!

1) Sept. 21: The Texas Chapter is co-sponsoring an event to educate medical students and residents about the benefits of Direct Primary Care.  Practicing physicians are encouraged to be there and take part in the Q&A with Josh Umbehr, MD, and Philip Eskew, DO.  The dinner workshop is being organized by the Texas Osteopathic Medical Association District II.  Click here for detailsand see the flier at the bottom of this message. If you know of other potential co-sponsors, please let us know.

2) Oct. 6: In conjunction with the 74th AAPS Annual Meeting in Tucson, AZ ,we will hold a Texas Chapter meeting and election of directors of the Texas chapter board. The meeting will be held during breakfast from 7am to 8am. The exact meeting room will be announced in the near future. More details about the AAPS annual meeting can be found at http://aapsonline.org/2017am.

3) Oct. 12-14: Our friends at the D4PC Foundation are hosting their 2nd DPC Conference in Orlando, Florida.  Click here to learn more.

Please stay tuned for future updates. Thank you for your service to the patients of Texas and your support of TxAAPS!

All for the Patient,

Sheila Page, DO
President, TxAAPS
president@texasaaps.org

You did it! Because of the hard work of so many in the physician community, SB1148 made it across the finish line. This has been a long journey. Thank you to all those who testified, wrote letters and made calls–your part was invaluable! 

The bill encountered major opposition from the hospital lobby, ABMS, and others who profit from MOC abuse. Sen. Dawn Buckingham, M.D., the bills author, and Rep. Greg Bonnen, M.D., the House sponsor, stood strong against the attacks and made sure the protections in the bill remained as strong as possible.

You can click here to read the final version as passed. We didn’t get everything we wanted this time but it is a major step towards the final goal of ending MOC mandates.

Here’s a summary of the main provisions in the final bill:

• MOC cannot generally be required for insurance company participation, or as a condition of payment for in- or out-of-network physicians.
• Most hospitals will no longer be able to require MOC for staff privileges. There were a few exemptions won by the Hospital lobby including medical schools and “comprehensive cancer centers, as designated by the National Cancer Institute.” For other hospitals, a compromise provision was included to allow MOC requirements only if the medical staff votes to authorize a requirement. The staff can also vote to rescind a requirement.
• MOC cannot be required as a condition of licensure.

Thank you again for your hard work! The journey is by no means over. We will continue to work on further improvements that will benefit Texas physicians and their patients.

A very hard-fought process has resulted in the passage of SB1148 through the Texas Senate 31-0.  We owe a huge thank you to Sen Dawn Buckingham for her efforts in making this happen.  

The next step for the bill is the Texas House. Please contact your Representative ASAP and ask him or her to support SB1148.

If you need to find out who represents you, please visit: http://www.house.state.tx.us/members/find-your-representative/

If you already know who your Representative is, you can visit http://www.house.state.tx.us/members/ and click on his or her name for contact information.

There were many revisions that were made to the original language, but the current text is very strong in prohibiting the typical onerous mandates and high-stakes testing required for maintenance of certification.  This is a victory for both patients and physicians and sends the message that our profession will not submit to the demands of corporate profiteers. The distraction of irrelevant busywork is detrimental to patient care–we can do much better than MOC to continually improve our practices.

The bill restricts the kind of compliance requirements that can be made for maintenance of certification.  It allows a more open and competitive market for various organizations to offer products that satisfy maintenance of certification criteria based on CME credits and without the previous intrusive and onerous mandates.  High stakes exams are prohibited.

Senator Buckingham also made sure that original certification stands and is recognized by the state of Texas.  She truly did everything possible to protect the patient and physician from intrusive testing requirements, including prohibiting the submission and sale of patient data by certifying boards.

Congratulations to Senator Buckingham!  Now, if the Texas House will follow suit, it will be a significant turn for the medical profession away from regulatory overload to a better focus on patient care.

4/8/2017 1am UPDATE:

Hello AAPS Members and Friends!

The time for the hearing that will include SB 1148 has been set for 8am on Tuesday, April 11.

COMMITTEE: Business & Commerce
TIME & DATE: 8:00 AM, Tuesday, April 11, 2017
PLACE: E1.016 (hearing room located on first floor of Capitol Extension)
For map of meeting room locations, click here and see page 3.

Here is a link to the official hearing notice:
http://www.capitol.state.tx.us/tlodocs/85R/schedules/html/C5102017041108001.HTM

The notice states: “Public testimony will be limited to 3 minutes. If submitting written testimony, please provide 20 copies to the committee clerk with your name and bill number on each copy.”

If you are attending and need help making 20 copies of your testimony please just let us know.

Additional important details provided below.

4/7/2017 6am UPDATE:

Thank you for showing such strong support for Dr. Buckingham’s bill to end MOC requirements, SB 1148!  Your comments to the members of the Business and Commerce Committee are being noticed and are making a difference.

We just found out that the Committee plans to include SB 1148 in their hearing next Tuesday, April 11 in Austin. The time hasn’t been announced, but as soon as we obtain the details we will let you know.

Here’s what you can do to help:

1. Physicians are needed to testify at the hearing. Typically, if the hearing starts at 8 am, it could take a few hours of waiting before it is your turn to testify. It can be a test of the will, so if you plan to give oral testimony, please be prepared to commit a few hours to the effort. Oral testimony is limited to 3 minutes typically. Please also bring a printed copy of your testimony to give to the committee.

2. Simply being present at the Capitol and registering to support the bill requires less of a time commitment (you don’t have to wait for your name to be called or for the full hearing) but is still a helpful way to show your support.

Please let us know ASAP, by replying to this email, if you can come to the Capitol Tuesday to help.

3. If you can’t be there in person, you can still give written testimony that can be submitted by someone else, without reading it, at the hearing (we can do this for you if you email us your testimony).

4. You can also send someone to testify on your behalf.  That person would state that he/she represents himself and then note that he/she will be reading the written testimony of Dr.____.

[NOTE: If you scroll to the bottom of this alert there is a template to guide your written testimony.]

Thank you again for your help in supporting this important legislation to benefit Texas patients and their physicians.

~Sheila Page, DO, Chapter President

3/31/2017

Dear Texas AAPS members and friends,

Help us fight for SB 1148 which will allow Texas physicians to focus on their patients and NOT meaningless busywork that detracts from time better spent on patient care. This bill, authored by Sen. Dawn Buckingham, would prohibit the requirement of MOC participation for insurance reimbursement and hospital privileges.

The members of the Texas Senate Business and Commerce Committee Need to Hear from YOU today in support of SB 1148! Here are ways you can pitch in to this crucial effort:

Step 1: Email and call the Committee members with a simple message along the lines of: “Please support SB 1148 and end mandates on physicians that interfere with patient care.”

For email you can simply copy and paste the following list of email addresses into the “to” line of an email:

david.mills_SC@senate.texas.gov, patrick.tyler@senate.texas.gov, Krista.heiden@senate.texas.gov, katrina.smith@senate.texas.gov, cristina.ojibway@senate.texas.gov, emily.dove@senate.texas.gov, doug.clements@senate.texas.gov, drew.graham_SC@senate.texas.gov, timothy.stostad@senate.texas.gov, president@texasaaps.org

Phone numbers can be found below. Calls, when they become numerous, deliver a strong message to the Senators—they need to know you are watching the process. Ask friends and patients to call or email, to bring the perspective from the patients’ side.

COMMITTEE CONTACT INFO

Chair, Sen Kelly Hancock:
(512) 463-0109, david.mills_SC@senate.texas.gov
Vice Chair, Sen Brandon Creighton:
(512) 463-0104, patrick.tyler@senate.texas.gov
Sen Donna Campbell:
(512) 463-0125, Krista.heiden@senate.texas.gov
Sen Craig Estes:
(512) 463-0130, katrina.smith@senate.texas.gov
Sen Robert Nichols:
(512) 463-0103, cristina.ojibway@senate.texas.gov
Sen Larry Taylor:
(512) 463-0111, emily.dove@senate.texas.gov
Sen John Whitmire:
(512) 463-0115, doug.clements@senate.texas.gov
Sen Charles Schwertner:
(512) 463-0105, drew.graham_SC@senate.texas.gov
Sen Judith Zaffirini:
(512) 463-0121, timothy.stostad@senate.texas.gov

Step 2: The most helpful action you can take is to write a formal letter of testimony and present it at the hearing (see template below). If you cannot physically be there, someone else can read your testimony, but they have to register in their own name, and read your testimony on your behalf.

Another helpful action is to go to the hearing and register in favor of the bill. You do not have to testify, but it is helpful when a few dozen people show up. Remember, the other side will be paying people to be there. That is why the doctors in the trenches get buried in punishing regulation—no one there really represents the working doctors.

I will do everything possible to help you if I know you are planning to be there. Typically, there will be only 48 hrs notice (another reason working doctors get left out of the process). Currently, what I have been told is that we will get a hearing in the Senate on Sen Buckingham’s bill, SB1148, within the next 2 weeks. That is unfortunately all I know for now.

Finally, don’t forget that YOU can make a difference!! If we the physicians cannot step up at this time to defend our profession and our patients, we will certainly continue to lose ground.

All for the Patient,

Sheila Page, DO
President, TxAAPS
president@texasaaps.org

P.S. For additional information on this issue please click here.

Formal testimony template:

Date

Business and Commerce Committee

Dear Chairman Hancock and members of the Committee,

1. My name is ____ and I am testifying in favor of SB1148.

2. State whom you represent—a business, an organization, or yourself, which is very common. (if you are reading someone else’s testimony, simply state your name and other information as above, that you represent yourself, and that you are reading the written testimony of Dr. ___.)

3. Describe your practice and your patients and keep this patient-centered as much as possible.

4. Your testimony should be brief. The hearings allow only 2-3 minutes for public testimony.

Here’s sample testimony to help guide your talking points:

This bill would ensure that my patients have access to me as their doctor by controlling how Maintenance of Certification (MOC) is used in Texas. I have no problem completing the 48 hours of Continuing Medical Education required by Texas law, but hospitals and insurance companies should not require doctors to waste time away from patient care on onerous MOC tasks. More importantly, the data is quite clear that MOC does NOTHING TO IMPROVE QUALITY OF MEDICAL CARE. See this JAMA article – https://goo.gl/qDdjqO – that shows that those with life-time Certification were just as good as those who re-certified with MOC.

Texas legislature seeks to delegate authority to a new interstate bureaucracy

The Sunset Commission bill for the Texas Medical Board, HB3040 and SB315, includes the Interstate Medical Licensure Compact, which, if passed, would bind Texas to a new quasi-governmental interstate agency with authority to grant expedited medical licenses for physicians who wish to practice in multiple states.

The Compact is new legislation that grants licensing and rule-making authority to an appointed Interstate Medical Licensure Commission that will have power to litigate against states from the US district court in DC.[i]  Additionally, the Compact’s disciplinary and investigative provisions are overly broad and may weaken physician due process rights.[ii] The rules written by this new licensing commission will be binding on states as law and supersede state law.[iii] Continue reading →

Dear Senators and Representatives of Texas,

The Federation of State Medical Boards (FSMB) posts its address as 400 Fuller Wiser Road Euless, TX 76039 and 1300 Connecticut Avenue, NW Suite 500 Washington, D.C. 20036. This Federation states its purpose as protecting the public through licensure and regulation and makes its money through licensure and regulation of medical professionals. Currently, physicians receive their license to practice medicine from the State of Texas. The regulation and discipline of physicians is under the auspices of the Texas Medical Board (TMB). The FSMB has been aggressively pursuing Texas, through the TMB, to join the Interstate Medical Licensure Compact designed by the FSMB, and if HB3040 and SB315 pass, Texas will become a part of this alliance. Reportedly, there is a lot of power behind these bills, including the support of the TMA. Continue reading →

HB1482 Shaheen and SB1818 Burton, permits the physician to dispense from the office.  This would apply most commonly to cash-based, or DPC practices that would dispense generic drugs at cost.  Some specialists would be able to help patients who are on Medicare and in the “donut-hole”, paying cash for their medications.

SB382 Burton, allows the physician to donate unused, unopened drugs from one patient who doesn’t need it anymore to another who is in need.

SB1148, Buckingham, HB3310 Zedler, and HB3216 Bonnen prohibits the mandate that physicians participate in Maintenance of Certification programs in order to retain hospital privileges or insurance contracts.

HB752 Meyers, SB833 Hughes requires that a CMO report to the medical board any facility that is interfering in medical decision making of the physician.  It also requires reporting of the CMO if he/she does not serve in this capacity to protect patients from perverse influence on the physician by administration.

HB2878 Sanford, Right of Conscience

Defends the right of a health care worker to refuse to provide a service that conflicts with his/her conscience.  This may apply in many circumstances, for example with corporate systems promoting assisted suicide and other forms of fast-tracking death. We currently have legal protection against coercion to perform abortions, but nothing else.

The bill that must be fought is SB315, Hinojosa, and HB3040 Burkett.

This bill is the Sunset Commission bill for the Texas Medical Board and embedded in it is the Interstate Medical Licensing Compact, which essentially creates a new agency with authority to grant expedited medical licenses for multiple states and write rules that are binding on the state as law and supersede state law.