Dec 23, 2008

Medicare: Staying Out of Trouble -- Podcast TMA

There’s a debate out there somewhere over just how many pages of regulations the government has published to govern the Medicare program. Thousands? Tens of thousands? Hundreds of thousands? The answer depends on how you define the word “regulation.” But for physicians and office staff, the answer is pretty simple. Medicare has TOO MANY rules regulating how doctors must care for their patients and what they need to do to get paid. Don’t follow those regs and you don’t get paid … or you end up on the wrong end of a fraud investigation.

Download the show. Today’s conversation is based on the release of our fourth volume of “greatest hits” from TMA’s practice management e-tips. To download the greatest hits or read through our other tips on coding, please check out the TMA web site. Our guests today are two of Texas medical association’s expert staff members. Genevieve Davis and Erin Gregorcyk are both reimbursement specialists in TMA’s Division of Medical Economics. Erin and Genevieve spend their days sorting through all those Medicare publications and then answering questions from our physicians. This installment covers:

  • Where can physicians and office staff find answers to common Medicare questions?
  • How can physicians change their Medicare participation status?
  • What should physicians do if they want to waive copays and deductibles for Medicare patients who can’t afford to pay them?
  • The new Medicare Advance Beneficiary Notice that physicians must begin using on March 1, 2009.
  • What do physicians need to know about documenting Medicare patient consultations?
  • How can honest physicians best protect themselves from making mistakes that might trigger a fraud investigation?
  • How can TMA’s mini-consults and coding hotline help physicians with Medicare problems or concerns?

Resources


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More Healthy Benefits From Tort Reform

Two reports released in December continue to document the positive effects of TMA's 2003 medical liability reforms. They're working.

More Healthy Benefits From Tort Reform

12/21/2008 6:00 PM

Be a First Tuesdays Lobbyist!

Physicians at the Capitol, in person, played a key role in organized medicine's victories during the past three sessions of the Texas Legislature. The 2009 session offers a chance to do it again. TMA urges physicians, medical students, and TMA Alliance …

Be a First Tuesdays Lobbyist!

12/21/2008 6:00 PM

Tell Us How Plans 'Lowball' You

Physicians, patients, and regulators around the country are increasingly outraged over how health insurance companies set "usual, customary, and reasonable" (UCR) charges or maximum allowables to determine payments for out-of-network services. We need …

Tell Us How Plans 'Lowball' You

12/21/2008 6:00 PM

CMS Surveying Medicare Contractors

The Centers for Medicare & Medicaid Services (CMS) may soon ask you what you think of the job that TrailBlazer Health Enterprises, the Texas Medicare carrier, is doing.

CMS Surveying Medicare Contractors
12/18/2008 6:00 PM

Ike Relief Fund Deadline Extended

 

March 16 is the new deadline for physicians to apply for financial help to rebuild their practices damaged or destroyed by Hurricane Ike.

Ike Relief Fund Deadline Extended

12/18/2008 6:00 PM

Dec 15, 2008

TMA's Prescription for a Healthy Texas

As you will read in the January Texas Medicine, the Texas Medical Association plans to pursue an ambitious agenda when the legislature convenes next month. A tight budget, narrow partisan margins in the Texas House and Senate, and an anticipated all-out …

TMA's Prescription for a Healthy Texas 12/11/2008 6:00 PM

Doctor's Orders: Attend Winter Conference

 

Make sure you're prepared to participate in the legislative process next year by attending the TMA Winter Conference Jan 30-31 at the Hyatt Regency Hotel in Austin.

Doctor's Orders: Attend Winter Conference

12/11/2008 6:00 PM

Save These Dates for 2009 TMA Conferences

 

Join physician colleagues from across the state for TMA’s three annual opportunity-packed conferences that will equip you to be more successful in your medical practice, advance the profession of medicine, and better serve your patients.

Save These Dates for 2009 TMA Conferences

12/11/2008 6:00 PM

United to Help Boost e-Prescribing

 

UnitedHealthcare is expanding its support of e-prescribing from small pilots in three states to include Texas and several other states. The Texas phase will begin in the Austin, San Antonio, and Waco markets.

United to Help Boost e-Prescribing

12/11/2008 6:00 PM

TMA Offers Coding Tools

 

Physicians go to medical school so they can learn how to take care of sick and injured people. But medical coding — putting the right codes in the right boxes in an insurance billing claim — is the financial engine that drives a medical practice. Correct …

TMA Offers Coding Tools

12/11/2008 6:00 PM

Dr. Zeitler to Head TMB

 

Irvin E. Zeitler, Jr., DO, of San Angelo, is the new president of the Texas Medical Board (TMB). Gov. Rick Perry appointed him for a term to expire at the governor's pleasure.

Dr. Zeitler to Head TMB

12/11/2008 6:00 PM

It's Decision Time on Medicare Participation

 

You have until Dec. 31 to decide if you want to change your Medicare participation status from participating to non-participating or vice versa for 2009.

It's Decision Time on Medicare Participation

12/11/2008 6:00 PM

Medco Changes Drug Policy

 

Medco is notifying Texas Health Insurance Risk Pool patients that as of Jan. 1, certain specialty medications previously obtained directly from a specialty pharmacy, a home infusion company, or their doctor’s office will be covered only if they order …

Medco Changes Drug Policy

12/11/2008 6:00 PM

MMWR Warns of Oseltamivir-Resistant Flu

 

Preliminary Centers for Disease Control and Prevention data show that 45 of the 46 influenza A (H1N1) viruses tested recently were resistant to oseltamivir; all H1N1 viruses were sensitive to zanamivir, according to the Dec. 12 Morbidity and Mortality …

MMWR Warns of Oseltamivir-Resistant Flu

12/11/2008 6:00 PM

Dec 2, 2008

Ike Relief Fund Deadline Approaching

 

Physicians needing help rebuilding their medical practices shattered by Hurricane Ike have only a month left to apply for assistance from the Hurricane Ike Disaster Relief Fund. The Physicians Benevolent Fund of TMA is accepting applications for …

Ike Relief Fund Deadline Approaching

11/25/2008 6:00 PM

TMA Introduces TMA Weekly Headlines

 

With new procedures, new technologies, and new regulations, physicians’ practices are constantly evolving. To that end, TMA has partnered with MultiBriefs to create TMA Weekly Headlines, an opt-out e-mail resource providing comprehensive news briefings of …

TMA Introduces TMA Weekly Headlines

11/25/2008 6:00 PM

Workers' Comp Conversion Factors Adjusted

 

The Texas Department of Insurance (TDI) Division of Workers’ Compensation announced in late November the annual changes to conversion factors for workers’ compensation medical fee guidelines for professional services, charges, and payments using the …

Workers' Comp Conversion Factors Adjusted

11/25/2008 6:00 PM

Survey Reveals Physician Frustration

 

Results of a nationwide Physicians Foundation survey show primary care physicians are frustrated and concerned about the state of medicine today, so much so that many of the of the 12,000 physicians surveyed say they would not recommend a career in …

Survey Reveals Physician Frustration
11/25/2008 6:00 PM

Receive Your PQRI Incentive Using DocSite

 

You are still eligible to earn the 1.5-percent incentive on your Medicare billing for 2008 by submitting Physician Quality Reporting Initiative (PQRI) measures through a patient registry

Receive Your PQRI Incentive Using DocSite

11/25/2008 6:00 PM

Blue Cross Billing Dispute Help Available

 

As part of the settlement in physicians’ national class action lawsuit against numerous Blue Cross and Blue Shield plans, physicians may submit billing disputes to a new external review board.

Blue Cross Billing Dispute Help Available
 
11/25/2008 6:00 PM

Your 2009 Goal: Stronger Practice Operations

 

Take a look back over the last 12 months. Was staff turnover high? Did your overhead increase?  Was cash flow down? Whatever your situation, resolve now to make 2009 better.

Your 2009 Goal: Stronger Practice Operations

11/25/2008 6:00 PM

TMA Offers Tools to Navigate the Coding Maze

 

Physicians go to medical school so they can learn how to take care of sick and injured people. But medical coding — putting the right codes in the right boxes in an insurance billing claim — is the financial engine that drives a medical practice.

TMA Offers Tools to Navigate the Coding Maze

11/25/2008 6:00 PM

AMA Hosts PQRI Webinar

 

The American Medical Association will host a webinar on the Centers for Medicare and Medicaid Services (CMS) 2009 Physician Quality Reporting Initiative (PQRI) from noon to 1:30 pm CST on Wednesday, Dec. 17.

AMA Hosts PQRI Webinar

11/25/2008 6:00 PM

TMA Winter Conference Coming in January

 

The Texas Legislature will be in full swing come January, and you won’t want to miss any of the action at TMA’s 2009 Winter Conference in Austin Jan. 30-31.

TMA Winter Conference Coming in January

11/25/2008 6:00 PM

Advertise for as Little as $25

 

TMA’s Web site experiences nearly 320,000 visitor sessions each month. With this kind of activity, can you afford not to advertise in TMA’s online classifieds?

Advertise for as Little as $25

11/25/2008 6:00 PM

Aetna Teaches Cross-Cultural Communication

 

Aetna is offering free online cross-cultural communication training for physicians, nurses, and health care professionals who care for Aetna members.

Aetna Teaches Cross-Cultural Communication

11/25/2008 6:00 PM

United Changes SPECT MPI Policy

 

UnitedHealthcare implemented a new medical policy for Single Photon Emission Computed Tomography Myocardial Perfusion Imaging (SPECT MPI) on Dec. 1.

United Changes SPECT MPI Policy
11/25/2008 6:00 PM

Nov 24, 2008

Survey: Primary Care Under Attack - Podcast TMA

The Physicians' Foundation "Medical Practice in 2008" national survey sought to learn whether current primary care practice conditions are eroding physicians' abilities to meet their patients' needs, and to learn more about the daily challenges physicians face, as well as medicine's future. The results show a bleak medical landscape in which primary care physicians are overworked, overwhelmed, and at the breaking point professionally and financially. The Physicians' Foundation plans to share the survey's findings so policymakers, employers, insurance companies, and the public will understand physicians' concerns. Download the show now. The cover story in the December issue of Texas Medicine delves into the survey's findings and examines how low physician morale, a weakened patient-physician relationship, time-consuming paperwork, reimbursement hassles, and other challenges affect the practice of medicine. In this installment of Podcast TMA, retired Georgia pediatrician Walker Ray, MD, vice president of the Physicians' Foundation, and Juan Jose Ferreris, MD, a San Antonio pediatrician in a four-person practice, discuss the threatened primary care practice environment. This installment covers:
  • The current physician shortage.
  • The effect of expanded health insurance coverage on a system that's collapsing.
  • What physicians can do to spread the message that primary care is in trouble.

Want to Subscribe to Podcast TMA through iTunes? Here's the link. It takes you to the iTunes store. Subscription is free. Catch up on all the old Podcast TMA episodes on the TMA Web site. What's a Podcast, how do I get it, and what do I with it once I have it? (See the short tutorial on the iTunes Web site.)

Nov 17, 2008

Thirteen Years of Service

San Antonio child psychiatrist Larry Stone, MD, served on the Texas Delegation to the American Medical Association from 1995 through 2008. His final meeting was the 2008 Interim Session of the AMA House of Delegates in Orlando, Nov. 8-11. Here, Texas Delegation Chair Sue Rudd Bailey, MD, presents Dr. Stone with a certificate commemorating his 13 years of service.

TEXPAC Scores More Victories

 

Ninety-three percent of the statewide candidates TEXPAC endorsed in the Nov. 3 election won their races, proving once again that physicians and alliance members make a difference when they get involved.

TEXPAC Scores More Victories

11/12/2008 6:00 PM

CMS Schedules PQRI Call

 

The Centers for Medicare & Medicaid Services (CMS) will conduct a conference call on the Physician Quality Reporting Initiative (PQRI) from 12:30 to 2:30 pm on Nov. 20. Following a short presentation, the lines will be opened to allow participants to ask …

CMS Schedules PQRI Call

11/12/2008 6:00 PM

New on TMA Online Communities

 

To learn more about the details of the state comptroller's audit of Medicaid payments and other news and resources on coding and billing for your practice, log on to the TMA Online Communities at www.tmacommunities.com.

New on TMA Online Communities

11/12/2008 6:00 PM

New Adolescent Immunization Toolkit Available

 

A new Be Wise — ImmunizeSM Physician Toolkit for Adolescents now is available from TMA.

New Adolescent Immunization Toolkit Available

11/12/2008 6:00 PM

CMS Puts RACs on the Shelf

 

The Centers for Medicare & Medicaid Services (CMS) says it has delayed the National Recovery Audit Contractor (RAC) program while the Government Accountability Office (GAO) reviews protests about the RAC contractor selection process filed by two vendors …

CMS Puts RACs on the Shelf

11/12/2008 6:00 PM

TMA to CMS: Reform the GPCIs

 

TMA's Council on Socioeconomics has urged the Centers for Medicare & Medicaid Services (CMS) to adopt more fair and rational methods for setting the Geographic Practice Cost Index (GPCI) modifiers to the Medicare physician payment system.

TMA to CMS: Reform the GPCIs

11/12/2008 6:00 PM

Register for DocSite's PQRI Webinars

TMA recognizes that the federal government's Physician Quality Reporting Initiative (PQRI) is not going away and will only become more prevalent with health care payment plans. There is a window of opportunity that allows physicians to earn bonus …

Register for DocSite's PQRI Webinars 11/12/2008 6:00 PM

Houston Symposium Targets Smoking

 

The state of smoking in Texas and future policy priorities will be discussed at the Texas Wellness & Smoking Policy Symposium Dec. 1 in Houston. Other topics include helping smokers quit and a preview of the 2009 legislative session.

Houston Symposium Targets Smoking

11/12/2008 6:00 PM

TMA's Hard Hats Wins PR Award

 

Texas Medical Association's Hard Hats for Little Heads won the Fan Favorite/Best Campaign Award from the Austin Chapter of the Public Relations Society of America (PRSA).

TMA's Hard Hats Wins PR Award

11/12/2008 6:00 PM

TMF Projects Promote Drug Safety

 

The TMF Health Quality Institute has started two quality improvement projects that target potentially inappropriate medications and drug-to-drug interactions. It says these projects should reduce adverse drug events that lead to emergency department and …

TMF Projects Promote Drug Safety

11/12/2008 6:00 PM

Texas Team on the Floor

On the floor of the AMA House of Delegates in Orlando, the Texas Delegation stands out. (l to r): Drs. Priscilla Ray, Dan McCoy, David Teuscher, Bob Morrow, Josie Williams, Carolyn Evans, David Henkes, Mary Dale Peterson, Linda Villarreal, Larry Stone, Bohn Allen, Tom Garcia, Kevin McKinney, and Lyle Thorstenson. The Orlando meeting was the last one for Dr. Stone, who is retiring from the delegation.

Nov 10, 2008

Physician, Heal Thyself

TMA EVP Lou Goodman,PhD; AMA President-elect Jim Rohack, MD; TMA Board of Trustees Chair Lyle Thorstenson, MD; and TMA Treasurer Art Klawitter, MD prepare for a morning stroll at AMA House of Delegates meeting.
(ORLANDO) -- One way for physicians to encourage their patients to take better care of themselves -- get more active, lose weight, quit smoking -- is to do it themselves.

Blogged Arteries today caught up with four TMA leaders who, in more ways than one, walk the walk. Today, they began their morning exercise at about 5:30 am. TMA EVP Lou Goodman, PhD; AMA President-elect Jim Rohack, MD; TMA Board of Trustees Chair Lyle Thorstenson, MD; and TMA Treasurer Art Klawitter, MD, rose early and posed for photos to help publicize the AMA's newest campaign to help patients take better care of themselves.

The AMA Healthier Life Steps campaign offers patients and their physicians tools and information to help them improve diet, increase physical activity, and eliminate unhealthy behaviors like risky drinking and smoking.

"Eating healthy, exercising and eliminating unhealthy behaviors like smoking and excessive or risky drinking can seem like daunting tasks if you try to tackle everything at once," said Dr. Rohack, a former TMA president, who will be a leading spokesperson for the campaign. "Incorporating small changes into everyday life, like cutting 100 calories per day and getting 30 minutes of moderate exercise, can make the process of getting healthier more manageable."

Nov 9, 2008

Live Coverage of AMA House of Delegates - Monday, Nov. 10

Students Raise Funds for UTMB Comrades

(ORLANDO) -- Medical students from across the country solicited their fellow students as well as residents and physicians at the AMA House of Delegates meeting to donate to the UTMB Medical Student Recovery Fund.

"I'm sure you all remember back to your student days and how hard it can be because we don't have any financial cushion to fall back on," Baylor College of Medicine student Meredith Williams told the delegates.

The moneys collected for the fund will go directly to students at the University of Texas Medical Branch at Galveston (UTMB), whose textbooks, computers, supplies, and personal belongs were lost, destoryed, or damaged by the flood waters of Hurricane Ike.

UTMB is the oldest medical school west of the Mississippi and home to more than 1,000 medical students. The institution trains about 20 percent of Texas' new physicians.

You can contribute to the fund via the Texas Medical Association Foundation's secure Web site.

Texans Testify for Texas Physicians

(ORLANDO) -- As the 2008 interim meeting of the American Medical Association House of Delegates moved into its second day, the Texas team spread out to offer insight, advice, and criticism on items on the agenda. Texas physicians had the opportunity to chair two of the five reference committees that took AMA members' comments on reports and resolutions this morning. The remainder of the Texas Delegation split into five teams to monitor the reference committee testimony and provide comments on their own. The reference committees will assemble the testimony and produce recommendations on every report and resolution for the full House of Delegates to take up tomorrow and Tuesday.

Your TMA team will offer live coverage of the house debate.

Texas Pushes Liability Protection Resolution

(ORLANDO) -- The Texas proposal to ensure that liability protection for physicians is equal to what may be offered to drug or medical devise manufacturers was well received this morning at the AMA House of Delegates. David Teuscher, MD, a Beaumont orthopedic surgeon, outlined the Texas plan (Resolution 201) in testimony before the AMA Reference Committee on Legislation. Listen to Dr. Teuscher explain the Texas position by clicking on the audio clip below.

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The full House of Delegates will take up the issue again tomorrow or Tuesday after the reference committee issues its recommendation. Be sure to follow TMA's live coverage of the house debate right here on Blogged Arteries.

Nov 8, 2008

Arens Honored with Distinguished Service Award

(ORLANDO) -- Calling him "one of the foremost leaders in the field of anesthesiology, ... a gifted educator and a champion of organized medicine," the American Medical Association today bestowed one of its highest honors on a long-time Texas anesthesiologist. James Arens, MD, received the 2008 AMA Distinguished Service Award for his his work to "dramatically reduce anesthesia-related mortality" and for his legacy as an educator. Hundreds of Texas anesthesiologists studied at his side. "Mentoring is one of the most important and satisfying rewards in life," Dr. Arens told the AMA House of Delegates. "Young physicians, residents, and medical students in the audience: Find a mentor and a role model; it is the most important choice you can make to be a success." Before his retirement earlier this year, Dr. Arens served for 42 years as a professor and chairman of anesthesiology at five premier medical schools, including The University of Texas Medical Branch at Galveston, the UT M.D. Anderson Cancer Center, and the UT-Houston College of Medicine. He served as president of the American Society of Anesthesiologists and of the American Board of Anesthesiology. "It is an honor to be a member of AMA, and even a greater honor to have been a physician," he said after accepting the award from AMA President Nancy Nielsen, MD.

"A mentor and role model for many physicians, Dr. Arens' services have exemplified the best in medical education," Dr. Nielsen said. The AMA Board of Trustees gives the Distinguished Service Award to an AMA member "for meritorious service in the science and art of medicine."

TMA and TMA Get Together Again

(ORLANDO) -- Decades ago, the "two TMAs" -- the Texas Medical Association and Tennessee Medical Association -- regularly caucused together at meetings of the American Medical Association House of Delegates. That practice has since gone by the wayside, but the states that shared Sam Houston and Davy Crockett decided to resurrect the tradition at the 2008 interim meeting of the AMA House. Delegates from both states broke bread together, shared small gifts, and discussed the issues of the day at working lunch today.

Texans Prepare for AMA House Meeting

(ORLANDO) -- With 2008 the interim meeting of the American Medical Association House of Delegates about to open this afternoon, Texas physicians spent hours this morning reviewing and discussing nearly 130 reports and resolutions that would set AMA policy and direct AMA action.

Hot topics include health care system reform, physician supervision of allied health practitioners, insurance company practices, Medicare payments, disruptive physicians, physician ownership of health care facilities, tobacco control, and medical homes. The 42-member Texas Delegation broke into five workgroups to the proposed action items before the house and take a stand on each. The reports and resolutions next go to five different reference committees Sunday morning, where AMA members can offer testimony, insight, and suggestions. The full house will take up the reference committees' recommendations in two open sessions beginning Monday afternoon.

Texans Bring Liability Resolution to AMA

Courts, Congress, and state legislatures shouldn’t grant pharmaceutical and medical device manufacturers immunity from liability simply because their products were used according to Federal Drug Administration (FDA) guidelines, and TMA says the American Medical Association (AMA) needs to get involved. “Physicians may become not simply the ‘deep pocket,’ but quite likely the ‘only pocket’ against whom patients who are injured by said drugs or devices may seek redress,” says a resolution the Texas Delegation is bringing to the AMA House of Delegates meeting in Orlando. The resolution also calls on AMA to support liability protections for “physicians who use FDA-approved devices and pharmaceuticals in a reasonable and prudent manner.” The resolution stems from a lawsuit, Wyeth vs. Levine, which the U.S. Supreme Court heard on Monday, Nov. 3. TMA joined with several organizations, not including the AMA, in filing a brief in the case. Below is the full text of Resolution 201:

Equality of Civil Liability Preemption for Physicians
Whereas, The physicians of America rely on the US Food and Drug Administration (FDA) to perform the vital role of ensuring the reasonable safety of pharmaceuticals and devices used in the diagnosis and treatment of their patients; and Whereas, The FDA Pre-Market Approval (PMA), 510k (substantial equivalence), and New Drug Application (NDA) processes are designed to ensure that physicians can prescribe, implant, and apply the devices and pharmaceuticals that are FDA-approved with reasonable assurance of their safety for patients; and Whereas, Despite the methods and standards that the FDA employs, manufacturers from time to time withdraw drugs and devices, reveal significant new safety information concerning such products, or make labeling changes such as the addition of a black box warning; and Whereas, Patients do, from time to time, have adverse events from appropriately prescribed FDA-approved pharmaceuticals and medical devices; and Whereas, The current FDA administrator has opined in court proceedings that FDA approval preempts the drug or device manufacturer from civil liability in state courts, but these proceedings do not address preemption for physicians who prescribe or utilize these same FDA-approved drugs and devices; and Whereas, The Supreme Court of the United States (SCOTUS) ruling in February 2008 in Riegel v. Medtronic upheld preemption of the defendant medical device manufacturer from civil liability, yet did not address the protection for physicians who use or implant said devices; and Whereas, The Wyeth v. Levine case now before SCOTUS involves similar issues of preemption for the manufacturer of an FDA-approved pharmaceutical, without addressing the preemption status of the prescribing physician; and Whereas, If manufacturers of FDA-approved products are unilaterally granted preemption protection in all contexts (including reasonable but non-FDA-approved uses of drugs and devices), physicians may become not simply the “deep pocket,” but quite likely the “only pocket” against whom patients who are injured by said drugs or devices may seek redress; therefore be it RESOLVED, The our American Medical Association oppose efforts to grant greater levels of liability protection for manufacturers than for physicians, whether by court decision or statute (New HOD Policy); and be it further RESOLVED, That our AMA support state and federal legislation that addresses the civil liability of physicians who use FDA-approved devices and pharmaceuticals in a reasonable and prudent manner, so that physicians have no less than the level of protection offered the manufacturer for adverse events resulting from the use of said products (New HOD Policy); and be it further RESOLVED, That our AMA report on AMA activities in support of this policy to the House of Delegates at the 2009 Annual Meeting. (Directive to Take Action)

Nov 7, 2008

Apply Now for TMA's Ike Relief Fund

 

The Physicians Benevolent Fund of the Texas Medical Association is now accepting applications for the Hurricane Ike Disaster Relief Fund.

Apply Now for TMA's Ike Relief Fund

11/2/2008 6:00 PM

Medicare Payments Up 1.1 Percent Next Year

 

The hard work in Congress by TMA and the rest of organized medicine last summer paid off last month when the Centers for Medicare & Medicaid Services issued a final rule raising 2009 physician payments by 1.1 percent. The increase takes effect Jan. 1.

Medicare Payments Up 1.1 Percent Next Year

11/2/2008 6:00 PM

AG Supports Outpatient Mental Illness Coverage

 

State law requires group health benefit plans to cover, based on medical necessity, at least 60 visits per year for outpatient treatment of serious mental illness, Texas Attorney General Greg Abbott ruled in an opinion issued in late October.

AG Supports Outpatient Mental Illness Coverage

11/2/2008 6:00 PM

Setting Up a Solo Practice? Don't Go It Alone

 

Are you thinking of opening a solo practice, but don't know where to begin? From securing a loan to hiring staff to choosing software and equipment, a myriad of tasks and important decisions awaits you.

Setting Up a Solo Practice? Don't Go It Alone

11/2/2008 6:00 PM

TMF Looking for Partnering Practices

 

TMF Health Quality Institute, the Medicare quality improvement organization for Texas, is seeking practices treating patients with diabetes to join a chronic kidney disease prevention initiative.

TMF Looking for Partnering Practices

11/2/2008 6:00 PM

TMB Selects Interim Leadership

 

The Texas Medical Board (TMB) named Austin pathologist Alan T. Moore, MD, as interim medical director, and Mari Robinson, JD, as interim executive director in October.

TMB Selects Interim Leadership

11/2/2008 6:00 PM

Cancer Institute Seeks Director

 

The Texas Cancer Prevention and Research Institute is looking for an executive director.

Cancer Institute Seeks Director

11/2/2008 6:00 PM

TDI Sets Workers' Comp Sessions

 

The Texas Department of Insurance Division of Workers' Compensation (TDI-DWC) will host a series of free educational sessions throughout the state in November and December for physicians and other health care professionals, employers, human resource …

TDI Sets Workers' Comp Sessions

11/2/2008 6:00 PM

TMA Convinces United to Cover Synagis Earlier

 

UnitedHealthcare responded to a request from TMA and the Texas Pediatric Society and changed its policy for covering administration of Synagis to patients at increased risk for complications of respiratory syncytial virus. United began covering up to …

TMA Convinces United to Cover Synagis Earlier

11/2/2008 6:00 PM

United Begins Premium Designation Course

 

UnitedHealthcare is offering an online continuing education course to help physicians understand the methodology it uses in its Premium physician designation program.

United Begins Premium Designation Course

11/2/2008 6:00 PM

Keep TMA Working for You: Renew Today!

 

TMA and many county medical societies began mailing their 2009 membership renewal statements in October. Don't wait to renew! The strength of the association's 43,000 members increases our leverage and collective ability to address the most important …

Keep TMA Working for You: Renew Today!

11/2/2008 6:00 PM

Nov 4, 2008

TMA Lands on YouTube

TMA has posted five new videos on YouTube. Two each promote our health outreach programs: Be Wise -- Immunize and Hard Hats for Little Heads. The fifth focuses on an El Paso physician who came to Texas solely because of our improved medical liability climate. Do you have some YouTube videos to add to our collection? E-mail Brent Annear.


The TMA YouTube Collection Hard Hats for Little Heads: Wear Helmets Hard Hats for Little Heads: Wear Helmets Right Be Wise -- Immunize: Vaccines are Safe, Effective Be Wise -- Immunize: Vaccines Don’t Cause Autism Medical Liability Reform Works (Dr Saracino Profile)

Oct 29, 2008

Apply Now for TMA’s Ike Relief Fund

The Physicians Benevolent Fund of the Texas Medical Association is now accepting applications for the Hurricane Ike Disaster Relief Fund. “The program’s purpose is to reestablish the delivery of medical care to the hardest-hit areas of Texas by providing physicians in need with financial assistance,” said TMA House Speaker Stephen L. Brotherton, MD, chair of the Disaster Relief Fund. “Grants are available if your practice incurred uninsured or non-reimbursable property damage and you do not have adequate funding to cover the damage.” Grants are available if the practice incurred uninsured or non-reimbursable property damage and does not have adequate funding to cover the damage. This includes relocating or rehabilitating the physician's medical office, obtaining replacement equipment, rebuilding patient records, and aiding staff; and paying temporary operating expenses, including rent for temporary offices and other working capital requirements. Practices in Angelina, Austin, Brazoria, Chambers, Cherokee, Fort Bend, Galveston, Grimes, Hardin, Harris, Houston, Jasper, Jefferson, Liberty, Madison, Matagorda, Montgomery, Nacogdoches, Newton, Orange, Polk, Sabine, San Augustine, San Jacinto, Trinity, Tyler, Walker, Waller, and Washington counties are eligible for assistance. Applications must be received by Jan. 5, 2009.

Oct 16, 2008

FDA Fluoroquinolone Alert Coming via HCNN

The U.S. Food and Drug Administration (FDA) is expected to issue a fluoroquinolone alert to physicians on Monday, Oct. 20.

FDA Fluoroquinolone Alert Coming via HCNN
 
10/14/2008 7:00 PM

CMS Cracks Down on Medicare Abuse

The Centers for Medicare & Medicaid Services (CMS) says it taking "aggressive new steps to find and prevent waste, fraud and abuse in Medicare."

CMS Cracks Down on Medicare Abuse
10/13/2008 7:00 PM

Obama Driving Doctors' Opinions

TMA's unscientific poll has produced some interesting results so far: With 615 TMA and TMA Alliance members responding, Republicans John McCain and Sarah Palin lead Democrats Barrack Obama and Joe Biden by a 52-41 margin.

Obama Driving Doctors' Opinions

10/13/2008 7:00 PM

CMEs Help You Help Patients Kick the Habit

Help your patients quit smoking by taking either of two continuing medical education (CME) courses offered by the TMA.

CMEs Help You Help Patients Kick the Habit

10/13/2008 7:00 PM

POEP Reminds Physicians of Cancer Resources

Texas has "valuable programs" for uninsured low-income women with breast or cervical cancer, according to A. Marilyn Leitch, MD, chair of TMA's Physician Oncology Education Program (POEP).

POEP Reminds Physicians of Cancer Resources

10/13/2008 7:00 PM

UTMB Students Need Help, Too

The University of Texas Medical Branch at Galveston (UTMB) has started the long process of recovering from the devastation of Hurricane Ike. UTMB sustained hundreds of millions of dollars in damage to its facilities and equipment

UTMB Students Need Help, Too 10/13/2008 7:00 PM

It's Time to Learn About Improving Quality

Physicians are ripe for education on the benefits of current quality of care programs, including the use of patient satisfaction surveys to assess performance and quality.

It's Time to Learn About Improving Quality

10/13/2008 7:00 PM

TEXPAC Endorses Champions for Medicine

The Texas Medical Association Political Action Committee (TEXPAC), TMA's political advocacy arm, has endorsed legislative and judicial candidates that its chair says will be "champions for patients and their physicians."

TEXPAC Endorses Champions for Medicine

10/13/2008 7:00 PM

TMA Helps Physicians Recover From Ike

With as many as 1,000 Gulf Coast area physicians needing help to pay for uncovered losses caused by Hurricane Ike, the Texas Medical Association and TMA Foundation are trying to raise $1 million help them get back on their feet.

TMA Helps Physicians Recover From Ike
10/13/2008 7:00 PM

Oct 7, 2008

Cracking the Code: Podcast TMA

Physicians go to medical school so they can learn how to take care of sick and injured people. They want to focus on diagnosis and treatment, not on putting the right codes in the right boxes in a billing claim. But we all know that correct coding is essential if you want to be paid correctly. And incorrect coding – if it’s bad enough – can get you in a heap of trouble. Download the show. Today’s conversation is based on the release of our third volume of “greatest hits” from TMA’s practice management e-tips. To download the greatest hits or read through our other tips on coding, please check out the TMA web site. Our guests today are two of Texas medical association’s expert staff members. Drena James and Erin Gregorcyk are both reimbursement specialists in TMA’s Division of Medical Economics. Erin and Drena know their stuff. They speak at seminars. They answer questions over the phone. Today, they’re here to share their knowledge with all of us. This installment covers:

  • Why is coding such a difficult problem for physicians’ offices?
  • What are some of the most comment E&M coding errors and what can doctors’ offices do to prevent them?
  • Coding for Medicare vs. Medicaid and commercial insurance.
  • How should physicians code for telephone consults?
  • Coding modifier and how they cause problems.
  • Consultations vs. referrals.
  • How TMA can help member physicians avoid coding problems and fight coding misinterpretations.


Resources


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Oct 6, 2008

Voices of Ike -- Galveston tent city

11:27 am, Monday, Oct. 6, 2008 Louise Geerts, executive director, Galveston County Medical Society This is a photo at the "tent city" in Galveston that is temporarily housing citizens who have lost their homes, have no place to go and no resources to relocate even if places were available. There are four tents that are half the size of football fields with cots lined up as far as you can see. This photo is Red Cross Disaster Relief Shelter 2. On the left is Rebecca Risinger, MD, UTMB Dept of Pediatrics. In the center is Frederick Zaunbrecher, MD, UTMB Dept of Internal Medicine, with his wife on the right, Michele Zaunbrecher. All three are also volunteers for The Luke Society that provides medications through its street ministry for the homeless every Saturday morning. The Luke Society won the complimentary grant of $2,500 in 2007 for the TMA Foundation's Champion of Health Award. I will send some more photos. Louise

Oct 2, 2008

CMS Announces PQRI Look-up Tool

The Centers for Medicare and Medicaid Services (CMS) says a new self-service look-up tool is now available on the Physician Quality Reporting Initiative (PQRI) Portal that allows physicians to see if their 2007 PQRI Feedback Report is available.

CMS Announces PQRI Look-up Tool

9/30/2008 7:00 PM

CMS Revises RAC Rollout Timeline

The Centers for Medicare & Medicaid Services has a new time line for the nationwide rollout of the Permanent Recovery Audit Contractor Program (RAC), the American Hospital Association reports.

CMS Revises RAC Rollout Timeline

9/30/2008 7:00 PM

Webinars Explain Fluoride Varnish Program

The Texas Medicaid program recently implemented a new fluoride varnish program allowing primary care physicians, physician assistants, and advance practice nurses to provide and be reimbursed for a limited oral health evaluation and application of …

Webinars Explain Fluoride Varnish Program

9/30/2008 7:00 PM

Medicare's Competitive Acquisition Program Delayed

The Centers for Medicare & Medicaid Services has postponed the 2009 Medicare Part B Competitive Acquisition Program for physicians until further notice.

Medicare's Competitive Acquisition Program Delayed

9/30/2008 7:00 PM

Earn CME Credit While Improving Patient Care

TMA e-Resources allows you to earn continuing medical education credit for improving patient care

Earn CME Credit While Improving Patient Care

9/30/2008 7:00 PM

E-Prescribing Improves Patient Safety

Each year in the United States, medication errors cause approximately 7,000 deaths, according to the electronic prescribing network SureScripts-RxHub. The reasons for such errors include illegible prescriptions, incorrect doses, and drug-drug or …

E-Prescribing Improves Patient Safety

9/30/2008 7:00 PM

AMA Webinar Targets Performance Improvement

An American Medical Association webinar on Wednesday, Oct. 8, will outline the increasing importance of continuing medical education (CME) in performance improvement (PI) for all physicians and will help doctors understand how and why to advocate for PI …

AMA Webinar Targets Performance Improvement

9/30/2008 7:00 PM

TEXPAC: 33 Days Until the General Election

TEXPAC, TMA's political arm, urges physicians to vote by Nov. 4 in the 2008 General Election. Early voting begins Oct. 20.

TEXPAC: 33 Days Until the General Election

9/30/2008 7:00 PM

Myriad Marketing Genetic Testing

Myriad Genetics Inc. has begun a direct-to-consumer marketing campaign in Texas for its BRCA1 and BRCA2 gene tests. Similar marketing in other states substantially increased demand for this type of genetic testing

Myriad Marketing Genetic Testing

9/30/2008 7:00 PM

How TMF Does Reviews

Do you understand the Texas Medical Foundation (TMF) review process? If not, the TMF Web site can explain it to you.

How TMF Does Reviews

9/30/2008 7:00 PM

Help Rebuild the Governor's Mansion

Physicians can help the state restore the 152-year-old Texas Governor's Mansion, heavily damaged by a fire started by an arsonist in June.

Help Rebuild the Governor's Mansion
9/30/2008 7:00 PM

Flu Season is Coming!

It’s not too early to start vaccinating as soon as you receive vaccine. Encourage your patients to get a flu shot as it is still their best defense against the influenza virus.

Flu Season is Coming!

9/30/2008 7:00 PM

Comptroller Clarifies Office Sales Policy

Physicians who sell health care products in their offices need to be aware of policy clarification from the State Comptroller.

Comptroller Clarifies Office Sales Policy

9/30/2008 7:00 PM

TMA Dues Statements Coming

TMA and many county medical societies will begin mailing 2009 membership renewal statements this month

TMA Dues Statements Coming

9/30/2008 7:00 PM

Chemical Dependency Counselors Back Down

TMA has persuaded the state's Licensed Chemical Dependency Counselor (LCDC) Program not to allow counselors to diagnose substance disorders. State law allows only properly trained physicians to make such diagnoses, TMA believes.

Chemical Dependency Counselors Back Down

9/30/2008 7:00 PM

HHSC Posts Ike Information List

 

The Texas Health and Human Services Commission (HHSC) says it expects legislation to be filed in Congress to provide relief for uninsured Hurricane Ike evacuees who seek medical care.

HHSC Posts Ike Information List
9/30/2008 7:00 PM

Voices of Ike - Galveston will rise again

5:18 pm, Thursday, Oct. 2, 2008 Galveston endocrinologist Kevin McKinney, MD

I believe that those of us at UTMB are going to do our darnedest to make it work on the Island. The contractors are swarming the campus at this time to make it ready for students and faculty, hopefully within a month. My wife, a full-time academician and researcher, is getting her hands and knees dirty every day down there. We have a very large research enterprise and infrastructure that can't be placed anywhere else, and a newly-built BSL-IV lab, so we have no choice but to stand and deliver! I agree that we will need to work with TMA, our county medical society and community physicians, and our alumni association when going forward.

We took a hard hit from this storm, but the Island and the County will rise again.

Sep 22, 2008

Voices of Ike - Back at work

4:29 pm, Monday, Sept. 22, 2008 Beaumont neurosurgeon Mark Kubala, MD
Back at work. Lot of elective case done today. Water is fine. Still about 75,000 without electricity. Lot of stores reopening. Saint Marys in Port Arthur is open and running also. Biggest hit was Bridge City and south Orange where flooding was up to 10 feet in places.

Sep 21, 2008

Voices of Ike - Help: Missing Person

4:32 pm, Sunday, Sept. 21, 2008
Houston trauma surgeon Ken Mattox, MD
I am appealing to our trauma network to attempt to find a missing person. A Mr. FRANK KEMERY was picked up one week ago on Monday in Galveston by an "out of town" ambulance and apparently taken either to the Ball High School or somewhere out of the area. He might have been transferred to the George R. Brown Convention Center in Houston, but I am so far unable to find out any information. His employer and family are looking for him and do not know where to start, thinking he would have surfaced by now. He was not registered at the Ben Taub General Hospital. This is a missing persons search, and not a clinical matter, so it is not a HIPPA violation. HELP if you can.

Sep 20, 2008

Voices of Ike - Full recovery is just around the corner

3:12, pm, Friday, Sept. 19, 2008 Galveston pediatrician, Ben Raimer, MD

Good day mates, We are drying out great and moving into our recovery mode. We have been blessed by NO RAIN and cool weather (low 70s) for the past five days. Otherwise, the heat and humidity would have been unbearable. We have power generators or REAL electricity from the grid to ALL of our campus buildings at this point, so we can really start moving on clean up faster. Water (not for drinking) is on at a low pressure. There are Port-a-Toilets, hand washing stations, military-style showers for staff, a dining hall on the parking garage top by Waverley Smith, and a good attitude. Dr. Callender is an absolute FANTASTIC LEADER. That guy goes from before sunrise to long after sunset. He must have a photographic memory. He knows every single detail of the whole operation, and in addition can call the names of almost everyone on campus. It really makes for a committed team of people to see him in charge. And countless others in the trenches are assuring that the campus returns to stability and moves us into the best possible position for the future. Photo 1 (above): OLD RED got a basement (ground level) full of water, but should be back on line. Dr. Lurlee Thomas is busy at home writing dean's letters, telling students to "STUDY now; it isn't over!" Dr. Lieberman has found placements for all the 3rd and 4th year students, and the 1st and 2nd year students should be back on line in a week. No, this will NOT interfere with your graduate or match dates. The only thing that might be an undesirable outcome would be for students to see this as a holiday and get distracted from their studies. Access your study guides and HIT THE BOOKS. Medicine is life-long learning; get used to it. Residents are successfully being placed and should immediately find out from Dr. Backwell their new assignments. Many clinical services will be conducted through St .Joseph Hospital in Houston, as well as through mainland area hospitals. The hospitals that have returned to operation in the area have enthusiastically welcomed UTMB physicians and patients into their facilities. Three community-based clinics opened yesterday and will also see patients on Saturday; more will open Monday morning. Information systems are becoming more stable and the patient systems (Envision and Signature) should be on line tomorrow, followed quickly by the student information systems. Updates are more timely now on the www.utmb.edu site, so please long on and check it our. Remember to register with FEMA, look for updates regarding payroll services and the like, and if you need to check in with EAP, do so. Phone and computer alerts will continue for employees and students. Photo 2: A crane setting a generator in place for the west end sewage treatment facility. If you were here (which you should be glad you are not) then you would really be happy about that crane and the forthcoming ability to FLUSH! I think it is VERY important for people to get back into a regular routine as soon as possible even if you are not in your home or on campus. Continue to study your normal time each day. Use the time to write a paper or prepare a lecture. Volunteer where you are to help others. Please do not just sit around and feel sorry for yourself. That is unproductive. We can never change the past; that is behind us. We can focus on our future and be sure that we put as much attention as we can into doing something about the things that we do control. Write, read, exercise, visit with friends, play some games with your kids. TURN OFF the TV coverage of the storm. Memorize the Red Cross Survival Guide for returning home (it's on their Web site - really). What will it be like when I return? Prepare yourself for some changes. Much of the debris that blocked I-45 has been removed, or at least shoved to the side. But you MAY still see some boats sitting on the side of the road. Along with jet skis, roofs, cars, houses, and just about anything that you can imagine. Buildings have a lot of structural damage along Broadway, the East End, and the like. There was a lot of water (and mud) damage on Harborview, and in areas west of 53rd Street. Rather than broken windows, you will likely see MUD on the floor and water lines. Cars are immobilized around the neighborhoods. Lots of downed trees all over town. Lots of burned out houses around Harve Lafitte! Looks like a battle ground. URBAN MYTHS

  • Were there really a lion and tiger loose on the west end? Yes there was! Police had to shoot one; I hear the other one is pretty hungry!
  • Were there cows on the heli-pad? Yes there were! Three! Dead from the storm.
  • Was there great loss of life on the island due to the storm? No, thank the Lord! There were a couple of tragedies and the dead of a couple of folks in hospice care.
  • How about Boliver? Don't know! Still awaiting some information.
  • Is there widespread looting and shootin'? Definitely NOT. Good coverage by the militia and local police. This is Texas! Guns galore. City officials are working night and day still!
Is it safe to return? I would not suggest that you come on the island with the idea of staying here very long -- if at all. Sanitation is not good; mosquitos have returned. Electricity is not dependable. If you have small children or fraile older parents, it would be a really bad idea to subject them to the climate and conditions. If I come down, what should I expect? Watch where you drive (nails). STOP at intersections and look all around. Bring some bleach to kill the mold if you got water. Bring your own drinking water, a flash light or lamp to look around inside. Bring mosquito repellant. If you want to tear out carpet, bring gloves (thick ones) and boots. Have you had a tetanus shot lately? If not, get one. Bring your own food. Bring trash bags. Bring any meds you are taking. Have a good day and a good weekend. Full recovery is just around the corner. Remember, UTMB stops for no storm. Ben

Sep 19, 2008

Voices of Ike - Almost endless need

Friday, September 19, 2008 11:24 AM San Antonio pediatrician Rebecca L. Huston, MD, MPH

I have had a very small role in the hurricane volunteer effort so far. I volunteered on Wednesday night at the Kelly shelter. It’s a pretty overwhelming atmosphere. They are set up in a huge warehouse, with the medical station at one end. There were many wonderful nurses and doctors volunteering under trying circumstances. I wish I had brought many things with me. Two of the most useful were hand sanitizer and books from my clinic’s Reach Out and Read program.

Most of the problems I saw were pretty routine: colds, earaches, tummy aches, and headaches. I did what I could, but at least I sent out each child holding a brand new book. The situation felt very similar to Katrina.

For many of the families in the shelter, I sensed almost endless need. Clearly Ike was only one of their many problems. My main hope was to offer a kind word and a listening ear.

Obama vs. McCain on Health System Reform: Podcast TMA

U.S. Rep. Michael Burgess, MD (R-Lewisville) told physicians attending Texas Medical Association’s 2008 Fall Conference that this year’s presidential election will be a referendum on health system reform. But where do the two presidential candidates stand on the issue of expanding health coverage to the uninsured? The cover story in the October issue of Texas Medicine takes a look at the health system reform proposals of both Democratic nominee Barack Obama and Republican nominee John McCain, who take far different approaches to helping the uninsured. In this installment of Podcast TMA, American Medical Association President-elect Jim Rohack, MD, and Roland Goertz, MD, a member of the American Academy of Family Physicians Board of Trustees, discuss how the candidate’s reform plans contrast and the prospects for major reform in the next congressional sessions. Download the show now. This installment covers:
  • The differences between the Obama and McCain health care proposals.
  • How the two plans stack up against reform proposals of the AMA, AAFP, and other national specialty societies.
  • Whether Congress is likely to enact major health system reform next year regardless of who wins the presidential race.

If you missed the great debate at Fall Conference, you can still read our detailed analysis of the John McCain and Barack Obama health care platforms and how they compare to TMA policy. While you’re at it, take the TMA 2008 Presidential Poll.


Want to Subscribe to Podcast TMA through iTunes? Here's the link. It takes you to the iTunes store. Subscription is free. Catch up on all the old Podcast TMA episodes on the TMA Web site. What's a Podcast, how do I get it, and what do I with it once I have it? (See the short tutorial on the iTunes Web site.)

Voices of Ike - A wonderful community of physicians

1:05 am, Friday, Sept. 19, 2008 Austin internist Frierson-Stroud, MD

The care of the coastal evacuees is evolving in both subtle and dramatic ways. I had a front row seat again today. I went by the Convention Center first. The Exhibit Hall was no longer subdivided into pods. A sea of cots coated the now essentially wide-open room. Another room was similarly set up. The hospital beds were essentially gone. This is due to the fact that the patients with medical needs had been moved to the U.T. J.J.Jake Pickle Research Center. When I walked in, at the Research Center's Common building, I found the now about 44 patients (down from greater than 90) in what is normally the basketball court. The nurses' stations were on center-court. The pods, A-G still, were placed in a circle around the center. Cardboard boxes held the charts. Again, the nurses, part of the City's Health Department, brought the patients to my attention. Most had already been initially assessed but one gentleman had just arrived. We had to convert his insulin in the same manner as on my previous day. Most of the problems were pretty routine. Meds were refilled (some have been there the week and others are running out of their meds).

Patients were also referred to vscular and orthopedic surgeons, neurologists and internists. Having seen before/after pictures of Galveston, patients from the island were referred to the clinics for longer-term care. I was later joined by a pediatrician who felt a bit like a fish out of water. However, she did a wonderful job providing primary care. She bonded with the DON, usually involved with pediatric immunizations, over vaccines. The saddest patient to minister to was a young woman who had a C-section about 3 weeks ago. Her incision had dehisced. She was getting home health to care for it, but she needed a VAC. She had a stony demeanor that was daunting. She didn't have a family according to her. This made me wonder where the baby was. I was, frankly, afraid to ask her if it had survived. Fortunately, the pediatrician was able to tactfully ask her. With relief I found the baby was with a friend. I looked for Mrs. K but she wasn't there. I hope she's gone home or to a nursing home. The 400+ pound woman was also not to be found. I recognized a few of the patients, including my old psychiatric patient. He's still a handful. The gentleman with the staph infection was still there although he spent a lot of time in the TV area. The cots for the most part were higher off the ground thanks to pads including air pads. The narrow cots were occasionally taped together to make the bed a more comfortable width. Hospital beds were mainly along the edges. One of the patients required a transfer to the hospital to rule out a DVT. Another was taken to a nursing home. The attrition will continue as the days go on. They are requesting volunteers thru September 25th. I'm hoping to drag a medical student with me the next time I come. I recognized the handwriting of one of my colleagues. He'd been there a few days before. I always thought he was a nice guy. Now I know. As my shift drew to a close, I was happy to be relieved by a former hospitalist. I knew the patients would be in capable hands. I took him on rounds as I showed him the ropes especially pointing out the problem patients. This crisis continues to bring out the best in the medical community. A radiologist who is a med school classmate (the second one I've seen since this started) was dropping off donations at the Convention Center. The pediatrician who left her comfort zone and family to come help those in need. The unknown number of physicians who have selflessly volunteered to care for their fellow man. Many, including the two I worked with today, are novices to this type of medical care. People like this reinforce what a wonderful community of physicians we have here in Central Texas.

Sep 18, 2008

Voices of Ike - On the road to being normal

12:12 pm, Thursday, Sept. 18, 2008 Houston cardiologist A. Tomas Garcia, MD

Well things are starting to look normal. Traffic lights are working, no lines at gas stations, ice boxes are full, and Whataburger has an Ike menu: burger, chips and drink. Keep it simple.

The hospital is full; but back to normal. The ER is busy but handling it well. The ICU has beds available, and the floors are sending patients home.

Power is coming back through out the city, water is okay, so what about less than a week to recover from a major cat 2 storm?

Boliver is sand and sea. Perhaps, the state should condemn the place and make a state park? How about galveston? thankfully we don't have to carry the mail on that one.

Guillermo and Carlos are helping out at the house with the limbs and trash. The house is okay. We're on the road to being normal. What is normal with a hurricane? Oh well, see you at the next TMA meeting.

Tom

Voices of Ike - East Texas hospitality

11:20 am, Thursday, Sept. 18, 2008 Crockett surgeon J. Patrick Walker, MD

Out of power and water for a few days. Now back up.

Stayed at the hospital and an evacuation clinic most of the time. Still have a few patients from the coast.

There are a number of second homes in and around Crockett that are open, if you know of any physicians from the Galveston area that need a place for a month or two.

Hope all is well with you.

Pat Walker

Sep 17, 2008

Voices of Ike - It can only get better, right?

9:43 pm, Wednesday, Sept. 17, 2008 Sugar Land internist Elizabeth Torres, MD

Hi, thank you for your concern.

We only lost electricity for 36 hours and had damage to fence and trees, which are trivial compared to what others have experienced. Also have my Dad staying with us until his lights are back.

Now trying to care for our patients under trying circumstances of limited communications and large surrounding areas of no electricity that persist. It can only get better, right?

Thanks again.

E. Torres,MD

Voices of Ike - We will reopen tomorrow

5:28 pm, Wednesday, Sept. 27, 2008 Texas City pulmononlogist Joseph Prince, MD

I am a physician at Mainland Medical Center in Texas City. I believe we were the only short term acute care hospital along the Gulf Freeway not to close our doors in advance of Hurricane Ike. I stayed on duty in house the night of the hurricane, but once the storm came we were forced to close our doors--but did take patients up until about 8:00 p.m. Power went out during the overnight hours but the backup generators were fully functional and overall the staff morale was excellent. Unfortunately, due to power loss in Texas City we lost running water and sewage in the early morning hours, resulting in the need to evacuate our facility. Fortunately I know of no patient deaths in our facility resulting from the storm. Although the OR was flooded, the hospital will reopen tomorrow and will have limited ER triage, minor surgical, and medical ICU capabilities. I am informed patients with igher level of illness will require transfer to another facility. It is our hope we will be able to decompress some of the medical needs of Galveston and the coastal areas during the closure of UTMB.

Voices of Ike - Hospitals filling up quickly

1:36 pm, Wednesday, Sept. 17, 2008 Houston cardiologist A. Tomas Garcia

Here is a picture taken during Ike with Carlos, graduate of the Royal College of Art/London, my youngest son who volunteered throughout Ike; Guillermo just arrived minutes from the airport from Afghanistan and helped out; Todd Great, ceo and leader of our hospital; me, and Dr. Carl Vartian physician liasion for the hospital.

All our suburban hospitals are filling up rather quickly. The medical center is having problems with power, water and/or telephone systems; so all the patients appear to be coming to local hospitals. As they fill, FEMA with their ambulances are taking the sick to San Antonio. It appears that there is a paradigm change, where in the past, patients would automatically go to the TMC; now it appears they are going to the local hospitals which really makes sense. For example, I have a patient just involved in a MVA and has a pulmonary contusion. She's quickly admitted and under my care with a pulmonary specialist to help out. all done in less than an hour. This can only help our patients.

Tom

Voices of Ike - Pizza by candlelight

11:48 am, Wednesday, Sept. 17, 2008 Houston cardiologist A. Tomas Garcia, MD

The problem is power. Many of the trees hit power lines, transformers, and poles at many key points. So they say. So the ramp-up has been great in some areas and slow in others depending on what the storm did. The hospital is now functioning normally. They figured out what the problem was with the generator and why it failed. Subsidence, it had actually drifted 2 inches since its installation, which was enough for the rainwater to shut it down. So when the hospital lost power on Saturday morning, the main back-up failed; we then went to emergency power which is minimal and will not run the AC, only the fan.

Currently the emergency room is seeing the car accidents, cuts, bruises, broken bones, and chain-saw accidents as predicited. This will probably continued for a while. Our doctors are opening our offices, but the patients aren't coming in. They're working at home cleaning up the mess and getting their accidents as predicted. Some businesses are starting to open and the lines at many of the gas stations are smaller now. It seems that the generators that everyone is using are taking a lot more of the gas. Everyone is trying to save their freezer and refrigerator food; as well as run AC units in one room and their television and/or fan. Reports are that this should improve as well.

The key is patience at this time. I lost everything in the freezer and refrig; my sons pitched it all. They found a pizza place open for business and so we enjoyed it with candlelight. The temp dropped with the windows open. I had my first night of rest at home after my first shower since Friday. Needless to say, a 12-hour sleep was just what the doctor needed.

Nuff for now.

Tom

Voices of Ike -- This is no place for people

[Editor's note: Thankfully, we are beginning to hear from physicians in Galveston, helping to put that great medical city back together. Here is a long post from UTMB Senior Vice President Ben Raimer, MD.] 10 am, Wednesday, Sept. 17, 2008 Galveston pediatrician Ben Raimer, MD

I have been on the island since Monday. Sharon, David and I weathered the brunt of the storm in Austin. The 400 UTMB employees who remained at the university transferred all remaining patients (including the prison) prior to the storm, shut down the Galveston National Lab (by the book), transitioned students, residents, and other personnel to safety, and then weathered a full day of battering wind, rain and water. The first floors of several buildings did flood, along with several parking garages. Overall, UTMB is located on one of the higher points of the island. Some of you will remember that University Blvd. actually sits on top of one of the early seawall extensions. There is, nevertheless, a significant amount of damage to equipment due to water and also due to the currently lack of power and dehumidification equipment. MRI's and other technology do not do well in the corrosive environment. Structures are intact and with a bit of cleaning (which is ongoing), will rapidly return to use. The entire island seems to have been submerged, except for a small area that was spared north of Avenue P. The Strand had over 8 feet of water in the street, and Shearn Moody Plaza which houses many of our UTMB services on 25th and Strand had about 6 to 7 feet in its first floor. 23rd Street had water all the way up to P, with the First Baptist Church across from Rosenberg Library as well as Trinity Episcopal Church both receiving water (FBC had a foot in its sanctuary). Sharon and I have an old building on 23rd and Strand that has apartments upstairs; many of our medical student friends as well as our son David (a UTMB resident) live there. There was 5 feet of water in the first floor, and one of student (Adam) had his car totally submerged in the garage to the building. There is mud, silt, debris (and a few dead fish) in the streets and buildings along 23rd. The East End Historical District lost a lot of its vintage trees to the water and wind. Major structural damage to the historical homes is evident as one drives by. I am told that our favorite restaurant, Rudy and Paco's, at 21st and Postoffice took on 6 feet of water at the peak of the storm. I am sure Paco will shop vac the place and be serving that great meatloaf sandwich in a few weeks. UTMB staff under the direction of Dr. David Callender are the real HEROS. Dr. Callender's calm leadership style and his ability to deal with a myriad of issues in an organized and orderly fashion certainly make him the perfect individual to guide the institution in this challenging period. His concern for people, their welfare, and their future mold his decisions. He seems to always be able to evaluate the situation, no matter how complex or difficult, solicit input from his talented staff, and make just the right decision for the moment --- ever mindful of the future that we plan to create. Today he has focused on the systemic issues of getting the campus back in operation as well as relief for a very tired staff. And, hats off to City Manager Steve LeBlanc and that wonderful "school-marm" Mayor Lyda Ann Thomas. Those two leaders have worked tirelessly day and night to assure the safety of the city, the assistance of those in need, and the recovery efforts. The mayor's calm and planful manner certainly gives the city's citizens hope for the future. Recovery would be easier if people heeded the mayor's words and realized that this is no place for people to be living at the moment. I cannot muster up much sympathy for those complaining of the lack of water, food or other amenities at the moment. All were ordered to leave, and transportation was provided. Not to chose that option and gripe later about one's own choice --- well, you know how I must feel about that. They need to get to safer circumstances as soon as possible; I hope that will occur within the next 24 hours. The public health issues without potable water are enormous. We must remember the health issues that make it an unsafe place to be. The city is trying to focus on restoring utility services, so the distraction of having to be a bed-and-breakfast for so many people is not good. And, if one adds in the distraction of having to direct police and fire personnel to chasing individuals with criminal intent around the island --- then that too is not good. Recovery resources are providing food, water, ice, and other services at designated locations (mainly Ball High School). First responders have been great. The outpooring of resources and people to step in and start the recovery is one of the best things about America. Volunteers! Tractors are moving trees, sea debris, and clearing roads. Day by day there are visible changes for the good. At UTMB: The research enterprise is stable. The National Lab was safely shut down without a problem. The structure was built for weather like we had (and more) so it is just fine --- nothing that a bit of soap and water on the first floor cannot correct. Dry ice and emergency generators continue to preserve specimens of value to future research, and the entire research enterprise team have done an extraordinary job in maintaining all systems. A federal team of HASMAT-type vets are also assisting with animal health (so far they are happy campers). It is too early to determine the status of machinery and technology; we can only hope for the best. Damage assessments are being performed by outside consultants. The clinical enterprise is shut down in Galveston, but our patients can call 409-772-2222 for assistance, and tomorrow three Community Based Clinics will be open to see their usual patients. Our Transplant Program is shifting its outpatient services to a mainland site, and will relocate surgical services temporarily to St Joseph's Hospital. Dr. John Bertini, a UTMB Alum and practicing urologist and head of the board of directors of St Joseph, has offered space for UTMB training programs. Other area hospitals, and programs in other states have also expressed their desire to assist in the recovery efforts. General surgery and anesthesiology will likely do some shifting to St Joseph in Houston. Other specialist will be deployed off the island into the community clinics as soon as that team can assure that utilities and support staff are in place. It is likely that hours will be extended to accommodate all of the UTMB doctors (they are eager to get back to their patients ASAP). For our patients, this means that clinical services will be back up and available on the mainland before weeks' end. Thank God for the amazing resilience of our health professional staffs! The educational enterprise has also moved into its disaster recovery mode, and students will be getting notices regarding resumption of their studies, locations for electives, and other instructions. Residents will also be deployed to nearby locations until services are operation that permits continuation of their programs on campus. Residency director Dr. Tom Backwell and Associate Dean Dr. Steve Lieberman have been working around the clock to confirm student and resident placements. Hats off to them and to their staffs for their efforts. Communication systems should improve today; FEMA is reportedly putting up some cell towers in the area. UTMB web is up and being updated regularly. Unless you have really important business in Galveston ... you should stay where you are are in a safe place until you hear otherwise. Exploring for yourself will not accomplish anything other than a long wait in lines, and you will be most likely turned away at this point. For those of you who have a pressing question about something, please email me and/or call me and I will try to help. Also, for students and residents (and faculty), you can call the UTMB general number and receive assistance. The dean's office numbers work, as do those in other areas. Remember 409.772-2222 for patient questions and/or general information. Patient records (EMR) should be back in operation by tomorrow or Friday so that mainland outpatient clinics can operate normally. The ER is open and staffed by federal HASMAT teams. All UTMB clinical personnel have been relieved of duty and asked to focus on recovery activities. The major jobs right now on the island are the restoration of power to the whole island, the restoration of potable water to the island and campus (there is no water at all ... not a drip from a faucet) --- so you can only imagine the sanitation issues that we face. There is no natural gas so one cannot boil water (hot showers and flushing toilets left the island with Ike's arrival). We stink --- what can I say. No amount of deodorant or aftershave will hide that fact. The UTMB campus has been secured so we feel reasonably safe. Yesterday after the "Look and Leave" policy was implemented, a lot of folks were allowed onto the island. 40% stayed in spite of the curfew and the orders. Last night also turned into a scary situation as intruders attempted to get into buildings around the island --- for purposes that only you can imagine. I was greeted today when I arrived on campus at 0630 from my home with police officers with machine guns! That's right --- machine guns! Our major priorities here now are security for our personnel and for the contract personnel who are doing the campus clean up. I am rethinking my plan to stay at home at night; I may camp out in my office from this point forward ... or until the "bad guys" go away. I understand that our city officials have "re-thought" their "L/L" policy and are now focusing on getting intruders out of two. We understand (cannot verify) that there were gunshots and the like around town last night. There is not a lot of stuff left to take; we only have 60,000 residents in this town and it is not like the island is home to incredible wealth. The Moody Mansion is about the only "mansion" in town, and it is filled with Sears furniture from 1890 Catalog (Mr. Moody was thrifty). They can have my 20 year old Sony TV; I may go home and put it into the drive way with a sign on it. I would also appreciate it if they would take the large garbage can filled with rotting meats, cousin Ann's delicious black-eyed peas, and the okra from cousin Lavelle's garden. Oh, and yes, they are welcome to the soon-to-be rotting carpets that Dave and I pulled from the house that filled with 16 inches of water. I would like them to get it out of the yard before the mold gets to the point that I'll need a lawn mower to deal with it. Overall, Galvestonian's are an optimistic group of people. They are the real survivors ... the people who will make their way into the future, step by step, with a successful plan. Islanders are resourceful, they work well collaboratively, and they work for the greater good of the community. Islanders understand that we are here because we choose to be here. The Rabbi and Pastor at First Baptist have already had a conversation about what worship places are usable, and how they can share --- not unlike the conversation between Rabbi Cohen and Dr. Harris some 108 years ago after that un-named storm claimed 8000 lives. We understand the risks, and we also understand our responsibility. And our faith keeps us focused on why we are here. After the 1900 Storm, the dean of the UTMB Medical School suggested to the UT System Chancellor that the school should close. The Chancellor's response, "The University of Texas stops for no storm." After 108 years, the message is the same. We have not stopped, and we do not intend to do so. This recent testing of our meddle has only reaffirmed our vision to create the future of health care for our people. It will be better; it will be relevant; it will be innovative; it will be strong. It will last through any of life's calamities. Ben