Dear Texas AAPS members,

Thank you to all who attended our chapter meeting in San Antonio!  We had a great turnout and the speakers were very informative.

Our keynote speaker, Dr. Waldman—Director of the Center for Health Care Policy at the Texas Public Policy Foundation—gave a superb presentation about Medicaid reform.  His presentation can be found here:
https://www.youtube.com/watch?v=Wihtf2AnaM4.

In addition, his new ebook outlining his solutions for reform was just released at Amazon: https://www.amazon.com/dp/B07CSK1MMK

Other presentations from our recent meeting can be found here:
http://www.texasaaps.org/category/video/

Ft. Worth physician, Dr. Kevin Wacasey—who spoke on “Busting the Big Myth of Health Care”—has two books exposing the harmful games health insurers play and strategies for overcoming their tactics: http://healthcareonomics.com/books/

Congratulations to the new board members! 

The result of our election of officers and board members is listed below:

Officers:

• President, Sheila Page, DO
• President-elect, John Dunn, MD
• Secretary, Steve Croft, MD
• Treasurer, Gil Robinson, MD

Board of Directors:

• Ray Page, DO, PhD
• Joseph Lukaska, MD
• Darren Meyer, MD
• Peter Curka, DO
• Ewa Stewart, MD
• Mary Morrow, MD

In other news:

The Texas Medical Board Sunset Advisory Commission met in May and voted May 24^th on the recommendations for changes to the Texas Medical Board. TXAAPS was represented by the chapter president, Sheila Page, DO, who submitted testimony and offered recommendations for changes that would help the way the TMB functions.  It was very encouraging to see that the Commission embraced some of our recommendations.

Background on the Sunset Commission.  In 1977, Texas established the Texas Sunset Advisory Commission to periodically review state agencies in order to make recommendations as to their reform or termination.  Since then most states have followed suit by establishing their own programs for sunset review of their state agencies.  Here is a good overview of state sunset commissions.  Florida, California, Minnesota, New Mexico, and other states have since established sunset commissions.  Oregon refused to establish mandatory sunset review, as reported here.

The Sunset Commission’s Recommendations:

The full list of the Sunset Commission’s recommendations is posted on its website here.

Among the recommendations adopted by the Texas Sunset Commission, the Commission agreed with us that adoption of the Interstate Medical Licensure Compact is not in the best interest of the patients, their physicians, and the state.  Instead, the TMB will be asked to adopt an expedited licensing process for qualified out-of-state physicians.  As part of this modification and as a management action, the Commission directed the Texas Medical Board to review its current licensing practices for out-of-state physicians and identify any necessary changes to statute or rules that are required to implement a new expedited process.

The Sunset Commission also agreed with us about requiring the TMB to disclose its expert reviews, requiring that they “share with the license holder who is the subject of the allegation a complete copy of each preliminary written report produced by each expert physician reviewer for the license holder’s case, not just the final report currently required by law.”

Another recommendation by the Commission was to take steps to limit the TMB’s posting of disparaging information about physicians, and to establish a central repository for complaints against the TMB itself, of which there are many.

The right to a Trial de Novo, for which TXAAPS advocated, was not included in the report, but was supported and recommended by Sen Bob Hall. It is very encouraging to have a Senator champion this cause, because the need for constitutional protection has been dismissed for many years.  Trial de Novogives the opportunity for a physician who wants to challenge a SOAH ruling to do so and request a trial by jury with an independent judge.  This will give the opportunity for a fresh look at the evidence and constitutional due process rights.  This is the only opportunity for the physician to have due process rights observed during an investigation.

As with many victories, we were not alone in our efforts.  There were other people who testified in support of physicians and the pressing need for due process rights in the function of the agency.  A patient advocacy group, Texas Right to Know, led by Sheila Hemphill, made many recommendations and supported ours. She did a tremendous amount of work at the Capitol talking to the members of the Commission about the need for improvements to the medical board’s processes.

TMA’s Dr. Carlos Cardenas  was also present to testify.  Although TMA had previously promoted the Interstate Compact, they were supportive of an expedited licensing process as well.

The fight is by no means over. We will keep you updated as the process moves forward in the 2019 legislative session.

All for the Patient,
Your Texas Chapter

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