Mar 12, 2014

Identity Theft

By Martha Leatherman, MD, Past President, Texas Academy of Psychiatry

Did I get your attention? It’s a real problem and affects people throughout the country, but the identity theft I’m talking about is the one you’re likely thinking about. The dictionary defines identity theft as “the fraudulent acquisition and use of a person's private identifying information, usually for financial gain.” I would like to propose another sort of identity theft that has been happening in American medicine for at least the last twenty years. It hasn’t made the news; it hasn’t been defined in our common vernacular; it hasn’t been declared a crime. That is because it has been widely accepted as a reasonable evolution of American medicine. The identity theft I’m talking about is the slow creep of para-professionals into the practice of medicine, and the use of the words “doctor,” and “physician” to mean things other than a professional who has devoted his life to studying medicine and has earned an M.D. or D.O.

The identity of “physician” has been stolen by the bureaucrats, the insurance companies, the legislators, and the special interests. We are now “providers” along with other “providers” such as acupuncturists, midwives, phlebotomists, and nurse aides. Often, these other providers allow patients to call them “Doctor.” Physicians graduate from medical school with tens of thousands of dollars worth of debt, heavy malpractice premiums, and expectations of perfect performance, but are paid not much more than the nurse practitioners they work alongside.

In another life, probably during the days of dinosaurs, physicians administered injections, drew blood, performed EMGs, and took vital signs. Now, many physicians do not even take a history from their patients. Increasingly, nurses and nurse practitioners counsel patients, perform procedures, take histories, write prescriptions, and make “diagnoses.” Nurse aides answer medical questions and perform minor procedures. Patients increasingly feel that they are getting their real medical care from paraprofessionals, and that the actual physician is little more than a figurehead. Physicians are boxed into algorithmic medicine and are required to follow the flowcharts devised by bean counters who are more interested in demographic outcomes than in what is best for an individual patient. Our work is digitized, analyzed, and criticized, but no one has ever captured the art that is medicine, and in trying, they are turning us into technicians.

This is identity theft. The professional identities of thousands of physicians have been stolen, and we have been left with identities we never wanted. The stereotype of a medical school applicant’s answer to “why do you want to be a doctor?” was always “because I want to help people.” It’s a stereotype because it was true of so many of us, and by “helping people,” we meant getting to know them and their families. We meant having our patients bestow on us a level of trust and caring that few are privileged to share with anyone. The television character Marcus Welby, M.D. is an icon because his character represents something that people long for, but now rather than being seen as helping, caring, professionals, we hear patients complain that “the nurse did all the work” and “the doctor spent less than three minutes with me.”

What does this have to do with the Texas Academy of Psychiatry? The Academy, along with our colleagues in the Texas Society of Psychiatric Physicians and other member organizations of the Federation of Texas Psychiatry have consistently worked to protect the professional identity of Texas psychiatrists. From the halls of the Capitol building in Austin to the bowels of regulatory agencies and insurance commissions, members of organized psychiatry work to protect physicians and our patients from expanding scope of practice by non-physicians as well as from the practice of medicine by legislative fiat. The Texas Academy of Psychiatry remains a professional organization of physicians who work together to network, educate, and support each other as we navigate the changing landscape of medical practice today.

We need your support to continue our work. Obviously, we have a lot to do and a lot to learn. Please join us.

This article appeared in the February/March 2014 issue of Texas Psychiatrist. Reprinted with permission.

Mar 3, 2014

DPS Announces Interim Plan to Renew Controlled Substance Permits

On Jan. 1, renewal of controlled substances registration (CSR) permits issued by the Texas Department of Public Safety (DPS) should have become part of physicians' biennial online medical license renewal with the Texas Medical Board (TMB). TMA advocated passage of House Bill 1803 by Rep. Bill Callegari (R-Katy) and Sen. Joan Huffman (R-Houston) to ease the administrative hassle and red tape on physicians when they renew their CSR permits, and to avoid interruptions in patient care and in physicians' practices due to inadvertent expirations.

Under the law, permits valid on Jan. 1 would automatically extend to the date of the physician's next state medical license renewal. At that time, the CSR permit would be valid for two years for a $50 fee.

TMB reports that it had completed the work necessary to implement HB 1803 by Jan. 1, including developing data-sharing capabilities that allow information to flow electronically to DPS for processing. DPS wasn't prepared, however, by Jan. 1 to allow for the two-year permit and to synchronize the expiration of the permit with the physician's license renewal date.

In the past, physicians have had problems when DPS didn't process renewals in a timely manner, before the CSR permit's expiration. When physicians are unable to renew their CSR permits, they can't prescribe medications. A physician's ability to prescribe medications hinges on possession of a valid CSR, which is necessary to obtain a permit from the Drug Enforcement Administration.

Just as critical, a physician whose CSR permit lapses faces (at least) temporary suspension of hospital privileges, as maintaining current certifications is a requirement to retain medical staff privileges in Texas.  

To address concerns among physicians and to ensure DPS is ready to begin processing CSR renewals, TMA has been meeting with department officials and TMB representatives. DPS told TMA in February that it will take at least six weeks to implement necessary changes to its processing system and to verify test data.

As an interim solution, DPS officials say they'll begin synchronizing the CSR expiration date with the TMB expiration date "in the near future." To ensure physicians don't experience any disruption in their controlled substances prescribing authority or place medical staff privileges at risk, DPS has posted the following information on its Controlled Substances Search and Verification System website:  

  • CSRs that currently expire in February 2014 or March 2014 will automatically be renewed by DPS with a temporary one-year expiration date. The renewal will be completed before expiration without the renewal application and associated fee. No action is required by the physician. The information on the Controlled Substances Search and Verification System will be updated.
  • Programming changes are under way at DPS to implement the statutory requirement to synchronize the CSR expiration date with the TMB expiration date.
  • Upon completion of the synchronization, the information on the Controlled Substances Search and Verification System will be updated, and new CSR certificates will be mailed to each affected practitioner.

Visit the DPS Regulatory Services webpage for updates and additional information as it becomes available.

Feb 9, 2014

Call Today! SGR Repeal Closer Than Ever

Late last week the "SGR Repeal and Medicare Provider Payment Modernization Act of 2014" (H.R. 4014/S. 2000), was introduced in the U.S. Senate and House of Representatives. Its author is U.S. Rep. Michael Burgess, MD (R-Lewisville). It features the handiwork of Rep. Kevin Brady (R-The WoodlandsAnd it has the support of key congressional leaders from both parties and in both chambers.

"We may not get this opportunity again," said TMA President Stephen L. Brotherton, MD. "Take action now to support permanent SGR repeal."

The three key congressional committees involved have come to this bipartisan, bicameral agreement in advance of the March 31 deadline when physicians' Medicare payments will be cut by 24.1 percent. It incorporates many Texas Medical Association-supported recommendations to reform the physician payment system and improve care for Texas seniors, military families, and people with disabilities. This legislation would provide physicians with positive annual payment updates of 0.5 percent for five years. (While these updates won't keep up with physicians' cost of providing health care to Medicare patients, the cumulative 2.5-percent update is larger than all of the increases Congress has provided in the past 12 years, combined.) It also includes important medical liability reform protections and significant financing and tools to help us adopt new payment and delivery models.

"Congress is now closer than it ever has been to enacting fiscally prudent legislation that would permanently repeal the SGR, "Dr. Brotherton said. "That will happen only if Washington hears our loud voice. Please contact U.S. Sens. John Cornyn and Ted Cruz and your U.S. representative today."

Physicians can send an email through TMA's Grassroots Action Center, and call lawmakers via the American Medical Association's Physicians Grassroots Network hotline at (800) 833-6354.

Here are the key points to stress:

  • For at least 12 years, members of Congress have told us how serious they are about reforming the Medicare physician payment system. Now that a bipartisan, bicameral policy has been developed, it is time to stop talking about the problem and seize the opportunity to solve it.
  • Congress must vote as soon as possible in support of a fix that will permanently repeal the flawed Medicare SGR formula.
  • Congress must avoid continuing the fiscally irresponsible cycle of short-term patches that contribute to the Medicare's program instability and do nothing to solve the underlying problem.
  • Congress must ensure that practicing physicians lead the development of the alternative payment models and quality incentive programs established in this bill.

"Please call or write today," Dr. Brotherton said. "We may not get this opportunity again."

Jan 22, 2014

Using Photos in the Medical Record? Use Them Right

In some fields of practice, such as dermatology, photographs are a common way to document a patient's condition and response to treatment. These records are no different from narrative records — the photo is meant to document what is necessary to achieve an adequate medical record and should be considered part of that record.

Many of the photographs will be smaller than 8½ x 11; the practice should either tape them to a full-sized sheet of paper or keep them a plastic slip cover, says the Texas Medical Association's Managing Your Medical Records. The photo should have identifying data on the reverse side.

Photos that contain sensitive anatomy should be safeguarded (as every single page of every medical record should be safeguarded).

Many surgeons make videos of surgeries, particularly surgeries performed via scopic equipment such as arthroscopy or laparoscopy. The practice should have a means (digital, disk, or both) to file and catalog the videos. Because the videos are a part of the medical record, a backup system is mandatory.

Some surgeons provide copies of the video to the patient. They should do this only pursuant to a practice-wide policy, developed in consultation with legal counsel and the medical liability insurer.

If you have questions about medical records, check TMA's Medical Records webpage for legal white papers, tips, and more. Or, contact the TMA Knowledge Center at (800) 880-7955 or knowledge@texmed.org.


See more, free Practice E-tips from the Texas Medical Association.

Nov 18, 2013

Two Outstanding Texans Honored by AMA

WASHINGTON, DC - Two stalwart members of the Texas family of medicine were honored at the AMA House of Delegates meeting.

AMA President Ardis Hoven, MD,
and Dr. Mattox

Houston trauma surgeon Ken Mattox, MD, received the 2013 AMA Benjamin Rush Award for Citizenship and Community Service. The award is given “for outstanding contributions to the community for citizenship and public service above and beyond the call of duty as a practicing physician.”

Dr. Mattox was recognized for his service in Houston’s medical response to several natural disasters, including Hurricanes Katrina and Rita in 2005 and Tropical Storm Allison in 2001. As part of the Katrina Joint Unified Command, Dr. Mattox helped form an “evacuation city” to house, treat, cloth, and feed 27,000 evacuees from New Orleans in only 18 hours.

The award is named for Benjamin Rush, an American Revolutionary from Pennsylvania, the only physician to sign the Declaration of Independence, and the surgeon general of the Continental Army. Dr. Rush is known as the “founder of American psychiatry.”

Marshall Cothran, CEO of the Travis County Medical Society and the Blood and Tissue Center of Central Texas, received the Medical Executive Meritorious Achievement Award. The AMA gives this award to a medical society executive who has provided exemplary and exceptional service that benefits and supports physicians in caring for their patients. This contribution “is exemplary beyond the normal scope of their duties or responsibilities.”

The AMA cited Marshall for “the financial turnaround of the Blood and Tissue Center of Central Texas [that] has benefitted patient care in Travis County and preserved the Center's independence as a local physician-governed asset to the community.”


Nov 17, 2013

What Doctors Can Learn From Each Other (TEDMED Video)

Different hospitals produce different results on different procedures. Only, patients don’t know that data, making choosing a surgeon a high-stakes guessing game. Stefan Larsson looks at what happens when doctors measure and share their outcomes on hip replacement surgery, for example, to see which techniques are proving the most effective. Could health care get better -- and cheaper -- if doctors learn from each other in a continuous feedback loop? (Filmed at TED@BCG.)