Summer 2016

Mission Statement

The mission of the Texas Chapter of the American College of Physicians is to promote quality health care for all Texans by strengthening the practice of internal medicine.

President's Message

Maureen Francis, MD, FACP
TXACP President

Dear Colleagues,

At all stages of our training and practice, we are encouraged to take time for reflection. So I ask you now to reflect on a controversial topic. Many of you have heard stories, as I have, from a patient, a family member or friend about surprise medical bills. The bill may be for thousands of dollars yet they have health insurance and wonder how they could be in this situation. Many times the bills are related to emergency services, surgery, or lab work. The patient believes they are going to an in-network facility but it may turn out that some of the providers involved in their care are not in their network. The surprise bills are related to balance billing. In the extreme, balance billing has been called the “ugly beast” of medical insurance.

This example from Healthcare.gov explains the problem:

When a provider bills you for the difference between the provider’s charge and the allowed amount. For example, if the provider’s charge is $100 and the allowed amount is $70, the provider may bill you for the remaining $30. A preferred provider may not balance bill you for covered services.

In addition, out of network charges may be much higher than in network fees, so the bills can add up quickly.

This problem affects Texas. The Center for Public Policy Priorities: Working for a Better Texas reports that one of the state’s largest insurers and its network hospitals” top the list with an eye-opening average of 68 percent of emergency room physician charges billed out-of-network for services delivered at an in-network hospital.” CPPC also reports that “8 percent of hospitals (23 of 276 hospitals) that contract with ALL 3 insurers (Texas’ largest insurers) have NO in-network emergency room physicians with any of the three insurers.” This means that insured patients who use these hospitals may receive large bills for emergency care.

As health care providers, we see the effects of narrowing networks and lack of cooperation from health insurers. Hospitals are negotiating independently with their interests in mind.  I am sure that the insurance industry also has their point of view.  Are we each like the blind man and the elephant, each only seeing a small part of the picture?

Can we try to step back and collaborate to appreciate the big picture? Our patients are being harmed by these practices. Our patients feel frustrated and angry and this is one more reason for them to lose trust with the medical system and with us. I hope we can all agree that our patients don’t belong in the middle of this dispute. Can Texas find a solution to end surprise billing by working together with our legislators to protect patients and encourage negotiation of fair contracts up front? Let’s work together to find an answer.

Sincerely,

Maureen Francis, MD, FACP

References

https://www.healthcare.gov/glossary/balance-billing/

http://kff.org/private-insurance/issue-brief/surprise-medical-bills/

http://www.huffingtonpost.com/tricia-spencer/balanced-billing-is-the-obamacare_b_5419026.html

http://forabettertexas.org/images/HC_2014_09_PP_BalanceBilling.pdf

http://forabettertexas.org/images/HC_2014_09_PP_BalanceBilling.pdf

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Governor’s Message

Sue S. Bornstein, MD, FACP
Governor, TX Northern Region

Where have all the preceptors gone?

With apologies to Peter, Paul and Mary I pose this question to the Texas ACP membership.

The Texas ACP General Internal Medicine Preceptorship Program (GIMSPP) has been the centerpiece of the Texas ACP’s programs and advocacy since 1995. This program pairs 1^st and 2^nd year medical students with internists and internal medicine subspecialists for 3-4 week rotations in the summer. Since 1995, we have placed 2,795 medical students in physician practices. There are similar programs in family medicine and pediatrics.

We have gathered data since the early days of the program that show that over time, approximately 35% of the medical students who participate in the GIMSPP experience enter an internal medicine residency. Although the last 5 years have shown positive increases in the numbers of students choosing internal medicine nationally (approximately 25% of all graduating medical students) there were many years of decline preceding this.

The program has been funded by the Texas Legislature through the Texas Higher Education and Coordinating Board. The main costs of the program are administrative (placing students) and students stipends. Students are given a stipend to help offset the cost of travel and other expenses. Preceptors are not paid but I can say without hesitation that preceptors find the experience to be worthwhile and invigorating and is a welcome reminder of why they chose internal medicine as a career.

GIMSPP saw decreases in funding in the 2009 biennium and in 2011, program funds were zeroed out of the state budget. Despite this setback, the Texas ACP continued to administer the program albeit at a reduced level. Our leadership felt that it was far too important a program to let die. After several years of strong and consistent advocacy on the part of the Texas ACP. TMA, Texas Academy of Family Physicians and Texas Pediatric Society, full funding for the program was restored in 2015. Additionally, the Texas ACP received grant funding from a Primary Care Innovation Grant to expand our preceptorship.

So let’s get back to my question. 2003 was the peak year for GIMSPP. That year we matched 240 students. This year, we have matched 163 students and summer is now in full swing. What has happened to account for the differences in match rates?

There are a number of issues that we have encountered in trying to find preceptors to accept students. First, there is no doubt that the hassle factor of being in practice (EHR, Meaningful Use, MOC, pre-authorizations, pressure to see more patients, and increasing complexity and chronicity) plays a role. Second, the dramatic increase in internists choosing hospital medicine as a career parallels the decrease in placements. Let me be clear that we welcome hospitalists as preceptors but have found that hospital regulations regarding students makes it difficult to match students in these settings. A third factor is the increase in employed physicians throughout the state. We have found repeatedly that policies in large physician groups make student placement more challenging.

Another factor that is at play here is that medical school curricula continue to change and fewer students have blocks of time for electives early in their medical education.

So while the need to get more students excited about internal medicine continues to increase, the availability of preceptors is decreasing. This is very concerning to the Texas ACP leadership and we have begun to explore ways that we can adapt GIMSPP to meet the changing landscape of medical practice.

At the 2015 Texas ACP Annual Scientific Meeting Dr. Susan Andrew, allergist from   Dickinson, Texas was awarded the first  Emerald Award for her 20 years as a preceptor. The following are excerpts from her remarks at the awards luncheon: “For the students, I hope they gain confidence in being able to interact with patients, families and staff. I hope that they feel comfortable with getting a history, doing a physical exam, coming up with a differential diagnosis and plan and then presenting the patient’s case. I hope the students will learn how to research medical problems and treatments. Since it might not be another year before further clinical experiences, I hope the students have had a sufficient clinical exposure ‘to keep them going.’” 

The GIMSPP offers what ordinary shadowing experiences cannot: immersion in the day-to-day work of an internal medicine doctor.  Think about the internists that inspired you to follow in their footsteps and consider becoming a preceptor. You’ll be glad you did.

"Medicine is learned by the bedside and not in the classroom. Let not your conceptions of disease come from words heard in the lecture room or read from the book. See, and then reason and compare and control. But see first." Sir William Osler

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2016 Annual Meeting Save the Date

Mark your calendar for the Texas Chapter of the ACP 2016 Annual Scientific Meeting!

November 5 - 6, 2016
The Omni Houston Hotel
4 Riverway
Houston, Texas

Hotel Information
A special block of rooms has been reserved at the Omni Houston Hotel.
Reserve your room online now
To make reservations over the phone, dial (800) THE-OMNI and mention that you are attending the Texas Chapter of the ACP meeting to receive the group rate.

Housing Rates
Single/Double occupancy: $159 *please note: This rate is available to registrants until the room block is full or Tuesday, October 4.  

We look forward to seeing you in Houston!

Event details to follow. Visit the website at www.txacp.org/annualmeeting

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Call for Awards

Nominate a colleague today for a Texas Chapter Award or National ACP Award

In recognition of outstanding contributions in Internal Medicine, the College offers 23 individual awards each year. From multiple teaching, research, public service, leadership and volunteerism, submit a nomination today to recommend an outstanding and deserving colleague. Do you know a highly accomplished person who demonstrates eminence in practice, leadership or medical research and ACP involvement? Confidentially nominate him/her for consideration in Mastership in the College, joining the 66 Texas members who have received Mastership since 1974. Deadlines for submissions are coming soon.  Learn more about the ACP Award and Mastership Categories here.

Recognize a colleague in Texas through the chapter's highest honors, including the Texas Chapter Laureate, Volunteerism & Community Service and Advocate of the Year awards.

The Texas Chapter Laureate Award is the most prestigious honor bestowed to a member at the local level. This award is designed to honor a few long-time Fellows or Masters of the College who have demonstrated by their example and conduct, an abiding commitment to excellence in medical care, education, and research, and services to their community, their chapter, and the ACP.

The Volunteerism & Community Service Award honors members of the Texas Chapter who have distinguished themselves in voluntary service in the area of medicine. 

The Snyder/Chumley Advocate of the Year Award presented by TXACP Services, recognizes a member of the chapter who has demonstrated outstanding leadership in the areas of legislative advocacy and grassroots activism.

These awards are not self-nominated. Nominations must include a detailed letter of recommendation and curriculum vitae; additional letters of support are welcome. Nominations are due to the Chapter business office no later than August 1, 2016. More information is available here.

View the 2015 Chapter Awards Brochure here.

Nominations for the Texas Chapter Laureate, Volunteerism & Community Service, and Advocate of the Year awards are due August 1, 2016. Awards will be presented at the 2016 Annual Meeting in Houston on Saturday November 5.

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Welcome New Resident Board Members & Nominations Open for the Chapter's Board of Directors

Welcome New Resident Representatives to the Board:
 

The Texas Chapter of the ACP needs a core of volunteer leaders to advance the mission to promote quality health care for all Texans by strengthening the practice of internal medicine. Are you looking for a new challenge? Want to take on a new leadership role representing your colleagues? 

The Board sets policy and provides leadership for TXACP, including planning strategically for the Chapter's growth; determining our mission, goals, and priorities; and allocating resources in line with those priorities. Nominations are due July 12, 2016. View the Board's job description online.

Members, Fellows, and Masters of the ACP are eligible for election to the board. Directors are elected to represent each of the state's five regions plus one at-large. Directors serve three-year, terms, starting 2016-2019. Board meetings are held three times per year to oversee the activities and programs of the chapter.   

Names of prospective candidates and curriculum vitae should be submitted or mailed to the Chapter business office at  401 W. 15th St., Austin, TX 78701; by fax to (512) 370-1693; or by e-mail to Nicole.Abbott@texmed.org.  If you have any questions, please contact the chapter office at 512-370-1528. 

Election results will be announced at the annual meeting November 5 in Houston at the Omni Houston Hotel.

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Students, Residents Call for Abstracts

The call for abstracts will be sent out Tuesday, July 7th. Deadline for submissions will be Wednesday, August 17th. Please make sure your contact information is up-to-date with the ACP. Residents and medical students are invited to submit new entries that have never been submitted in the past for several competitions during the Texas Chapter of the ACP Annual Meeting November 5-6 in Houston. 

Medical Student Poster Competition: Medical students are invited to submit abstracts of clinical vignettes that have clinical relevance to internal medicine to the 2016 medical students’ poster competition via the medical student abstract submission form on the Texas chapter’s website. On the submission form, students can indicate whether they want their abstract considered for the poster competition only or for the poster and/or clinical vignette competition.  In order to submit an abstract for either competition, you must be a member of the American College of Physicians.

Resident Poster Competition: Residents are invited to submit abstracts of clinical vignettes, clinical research (not basic science research), and quality improvement-patient safety that have clinical relevance to internal medicine to the 2016 residents’ poster competition via the resident abstract submission form on the Texas Chapter’s web site.  In order to submit an abstract for either competition, you must be a member of the American College of Physicians. 

Andy Diehl On Being a Doctor creative writing competition: Residents and medical students are invited to submit original prose or poetry dedicated to a particular theme. Submissions are limited to 1,000 words or less and must be submitted via the submission form on the Texas Chapter of the ACP web site. 

A panel of physicians will review the submissions, and the winner will be announced in October.  The winning author will be invited to present his or her work in a 10-minute oral reading during the general session at the Annual Meeting and will be recognized with the Andy Diehl on Being a Doctor Award. The author will win a trip paid for by the chapter to attend the Texas Chapter of the ACP Annual Meeting in Dallas and a trip to attend IM2017 in San Diego, CA in March.

2016 Doctor's Dilemma Competition Team Form: Test your knowledge in the popular Resident's competition at the annual meeting. The first place team for Texas Northern and Texas Southern region will advance to the National ACP competition held March 30-April 1, 2017 in San Diego, CA during the ACP Annual Session at IM2017.  Members of the team who advance to the national competition must be Resident ACP members in good standing.  Please contact Becca Lawson in the chapter business office at (512) 370-1463 or e-mail her at rebecca.lawson@texmed.org with questions.

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ACP Regional Competitions Resident Winners

All across the state of Texas, internal medicine residents are hard at work learning, practicing, and teaching medicine. The Texas Chapter of the ACP has the honor of allowing these young physicians to showcase their hard work locally at one of our five Residents’ regional competitions.

This year’s meetings followed in the successful tradition of those of the past. Competition was stiff, participation was high and all of the work was exceptional quality. An enormous amount of time and energy went into the planning of each event. Recognition for the extensive meeting preparation goes to Dr. Alejandro Moreno for the Southwest region, Dr. Philip Orlander for the Southeast region, Dr. Kenneth Nugent for the Northwest region, Dr. Leigh Hunter for the Northeast region, and Dr. Pedro Blandon for the Far Northwest region. Thank you all for your diligence and hard work.  A special thank you goes out to Drs. Suma Pokala and George Crawford for all of their involvement with these regional events as the Texas Chapter of the ACP Residents Committee Co-Chairs.

The Texas Chapter supports the regional Residents’ councils with annual grants of up to $1,000 per Council to help fund their programming. Each regional clinical vignette competition winner will receive Chapter support to allow them to travel to Houston, November 5-6, 2016, to represent their region at the Annual Meeting.

Congratulations go to the following regional competition winners!

SOUTHEAST
Oral Vignette Presenters:
First Place:
Rose Ngishu (UTMB)

ACP Resident representative elected to the Board:
Farrell Tobolowsky (Scott & White)

NORTHWEST
Oral Vignette Presenters:
First Place:
Mohamed Qureshi, MD (TTUHSC-Permian Basin)

ACP Resident representative elected to the Board:
Brittany Rosales, MD (TTUHSC_Lubbock)

NORTHEAST
Oral Vignette Presenters:
First place:
Ravina Patel, MD ( Methodist Dallas Medical Center)

ACP Resident representative elected to the Board:
Mehul Shah, MD (UTHSCT-Good Shepherd Medical Center)

FAR NORTHWEST
Oral Vignette Presenters:
First place:
Gehan Botrus, MD, PhD (TTUHSC El Paso  – internal Medicine)

ACP Resident representative elected to the Board:
Miraie Wardi, DO (TTUHSC El Paso– internal Medicine)

SOUTHWEST
Clinical Oral Vignette Presenters:
First Place:
Chhaya Patel, MD (TX A&M Baylor Scott and White)      

ACP Resident representative elected to the Board:
Jimmy Widmer, MD (TX A&M Baylor Scott and White)

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GIMSPP Match Update for 2016

The GIMSPP continues to thrive after receiving and implementing its grant funding through this year.  As of June 23, 2016, we have been able to match 163 students – which is the highest number of matches made since 2003. We have seen a 72% increase in match numbers since 2015’s final match number of 95.

The number of rural and underserved area preceptorships is 68, which is a robust 42% of matches this year.  One of the goals of the Primary Care Innovation grant is to match students in rural or underserved areas to help fill the need for primary care, and the program has delivered.

There are four preceptors who qualify for the Decade of Service Award this year, which is given to preceptors who have been a preceptor for 10 years and have hosted students for at least 7 of those years.  Those preceptors are: Dr. Aaron Samsula, MD; Dr. Michael Marshall, MD, FACP; Dr. Margaret Hayden, MD, FACP; and Dr. William Pieratt, MD. 

The GIMSPP’s primary goal is to match 250-300 students for 2017.  In order to do this, we must recruit preceptors heavily in anticipation of this influx of student applications.  If you want to help by becoming a preceptor, fill out the availability form.  We will need many preceptors in rural practices around the state and in high-need areas such as Houston, San Antonio, Dallas, Fort Worth, and Austin.

If you wish to serve as a preceptor for 2016, please contact Laura Tolin at Laura.Tolin@texmed.org or visit the GIMSPP webpage for more information.

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Thank You to All of Our Summer 2016 Preceptors

The General Internal Medicine Statewide Preceptorship Program would like to thank all of the physicians that served as preceptors for medical students this summer. Their dedication to the program, the students and to internal medicine is greatly appreciated.

To learn more about the Preceptoship Program please read more here or contact Program Coordinator Laura Tolin at laura.tolin@texmed.org.

DSME and Diabetes Prevention Campaign Outreach

Empower Your Patients with Diabetes Self-Management Education

Diabetes education works. But less than 60 percent of people with diabetes have had formal diabetes education. Physicians can increase that number by referring their patients with diabetes to Diabetes Self-Management Education (DSME).

Research shows that people who have received diabetes education are more likely to:

• Use primary care and preventive services
• Take medications as prescribed
• Control their blood glucose, blood pressure, and cholesterol levels
• Have lower health costs

The Texas Diabetes Council and the Texas Department of State Health Services have created new materials for providers to empower their patients with diabetes through DSME. The message to patients is, “Do you have diabetes? Help yourself to better health.”

Physicians and healthcare providers can access the updated Texas Diabetes Council toolkit, download or order free educational materials, and locate local DSME programs at www.tdctoolkit.org. Materials include:

• A poster for display in physician offices
• An informational card and fact sheet for distribution to patients
• A patient referral form in tear-off pads for physicians to refer patients to a DSME program. The form also features an algorithm that defines four critical times to assess, provide, and adjust DSME

Diabetes self-management education is a benefit covered by Medicare and most health plans when provided by a diabetes educator within an accredited/recognized program.

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Advocacy Day 2016

The 85th Texas Legislative Session convenes January 10, 2017. The Texas Chapter of the ACP Services invites you to mark your calendars for this advocacy day. Bring visibility to issues impacting your patients and your practice to legislators and staff at the Capitol in Austin. 

TXACP Services Advocacy Day

Thursday October 20, 2016
(details to follow)

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Welcome New Members

We are proud to welcome the following members who have joined the Chapter during the past 3 months:

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ACP Recruit-a-Colleague Program

Recommend ACP membership to your colleagues and earn a significant discount on your membership dues or even free membership. Now you have the opportunity to provide your colleagues with the same clinical support and educational resources that you have enjoyed as an ACP member. READ MORE

ACP Member Benefit Highlights Flyer
 

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Member Kudos

Alejandro Moreno, MBBS, MPH, JD, FACP, FCLM, of Austin received the ACP's Annual Richard Nuebauer Award for advocacy efforts Read More.
 

Carlos J Cardenas, MD, Edinburg Physician Elected TMA President-Elect. Read full press release here.
 

Lynne Marcum Kirk, MD, MACP, of Dallas receives the Platinum Award, the top honor in the Texas Medical Association (TMA) Award for Excellence in Academic Medicine. Read full press release here.

Dan Stultz, MD, FACP, past president and CEO of the Texas Hospital Association, was presented by the The American Hospital Association with its Honorary Life Membership Award in recognition of his contributions to hospitals and health care in America. Read full press release here.

TCOM Student, Patrick Crowley, named TMA Student of the Year. Read full press release here.

Cynthia A Jumper, MD MPH FACP, a Lubbock internal medicine specialist who’s been an active member of organized medicine for more than 22 years, was reelected to serve as a Texas alternate delegate in the American Medical Association (AMA) House of Delegates, the national organization’s policymaking body.  Read full press release here. She was also selected to serve on the AMA's Council on Medical Education.  See more here.

Roxanne M. Tyroch, MD FACP, an El Paso internist in practice for 21 years, was reelected to represent Texas physicians as an alternate delegate to the American Medical Association’s (AMA’s) House of Delegates, the national organization’s policymaking body. Read full press release here.

Elizabeth Torres, MD FACP, was one of Six Houston-area physicians were elected to represent Texas doctors in the American Medical Association’s (AMA’s) House of Delegates, the national organization’s policymaking body. Please read full press release here.

UT Southwestern medical students honored by White House for hepatitis awareness efforts. Tyler Smith, a fourth-year medical student who co-directs the program with fellow student Minh-da Le as part of the Asian Pacific American Medical Student Association at UT Southwestern. Read full press release here.

Jesus Vera-Aguilera, MD, who received his internal medicine residency training at Texas Tech University Health Sciences Center at the Permian Basin, has earned a rare honor. He was recently awarded a fellowship at the prestigious Mayo Clinic. Read full press release here.

Send news of your accomplishments, or that of a colleague, to: Becca Lawson, TXACP Staff, 401 W. 15th St., Austin, TX 78701; fax to (512) 370-1635; or e-mail to Becca Lawson.

Thank you for being a member of the ACP.

For more information on the Texas Chapter of the ACP activities, news and photos, join us on Facebook.

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