SAFE Opioid Prescribing: Strategies. Assessment. Fundamentals. Education
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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.
Maureen Francis, MD, FACP
After many years in practice, I still learn the most poignant lessons from my patients. Imagine a middle-aged man who works as a gardener, not unlike someone who may work for me or for you in the course of caring for our lawns or flowers or landscaping. This gentleman was admitted to the hospital with a severe infection of his foot which he injured while working. He depended on his work to pay his rent and other bills so he continued and did not seek medical attention until he was unable to walk. He did not know that he was diabetic. The wound was drained and he was placed on broad spectrum antibiotics but this was not enough and amputation was recommended. He was in the “coverage gap” with no health insurance and no preventive care.
What is the “coverage gap” and what does it mean for Texas? The “coverage gap” refers to poor adults who fall through the cracks for health insurance because they don’t qualify for current Medicaid and their income is below the lower limit for Marketplace premium tax credits. Texas currently has stringent eligibility criteria for Medicaid. For example, adults without dependent children are not eligible at all unless they are disabled. Adults with dependent children are only eligible if their household income does not exceed 18% of poverty level - this is about $3,600 a year for a family of 3. It is worth noting that the majority of adults in the “coverage gap” come from a family with a worker, and half are working themselves, mostly in agriculture and service industries.
Medicaid expansion was intended to cover this gap but the Supreme Court decision in 2012 made it optional for states. In Texas, 766,000 poor adults fall into this gap and are left without coverage. This is approximately 25% of the 3 million poor uninsured adults who fall into the “coverage gap” nationally. If Texas continues down the current path, the state will miss out on $100 billion dollars. This is federal money that would have come to Texas to provide for low income residents. Texas hospitals are losing money too as they provide an estimated $5.5 billion annually treating patients who don’t have insurance.
These are the numbers but I ask you to remember that each of these 766,000 is a person with a name and a story of their own. The Institute of Medicine calls for care in the 21st century to be patient-centered, safe, effective, timely, efficient, and equitable. Think about timely and equitable care for our patients. It makes sense from both a humanistic and an economic standpoint. Texans are falling through the gap in health care coverage and challenging us to examine our assumptions. I understand that the problem is multi-factorial and that insurance does not automatically equal access to quality care, but I ask you today to open your minds and your hearts to work together to find a path forward that offers a better option for all Texans.
The Coverage Gap: Uninsured Poor Adults in States that Do Not Expand Medicaid – An Update. Available at http://kff.org/health-reform/issue-brief/the-coverage-gap-uninsured-poor-adults-in-states-that-do-not-expand-medicaid-an-update/
Texas Medicaid: eligibility, enrollment and benefits. Available at
George E. Crawford, MD, MACP
Governor, TX Southern Region
Congratulations to Sue Bornstein, MD, who hosted the recent very successful Texas ACP meeting at the Dallas Renaissance Hotel. 321 attendees learned about practice management, mindfulness and spirituality as well as a variety of conventional medical topics.
The Regional Residents’ days are being held in April and May. Support your local training programs and meet your future colleagues by attending. The five meetings are being held in Houston, Lubbock, Dallas, Austin, and El Paso. Click “Residents” on our website for details.
The GIMSPP program has been on life support since its funding was revoked in 2011. In a dramatic turn around, the legislature has appropriated $1 million dollars for the 2016-2017 biennium, allowing student stipends for the next two summers of the program. Applications by MS-1s and MS-2s have increased to 224 this year. Unfortunately as of this writing, we have only 140 preceptors. Preceptors mentor students for 2-4 weeks in their practices, and can share the student is other members of their group. We need more volunteers! For more, click the GIMSPP link on the Texas ACP website.
Mark your calendar for the next Annual Texas Meeting, November 5-6, at the Omni Houston.
The General Internal Medicine Statewide Preceptorship Program (GIMSPP) provides first and second year medical students with a community-based clinical experience of general internal medicine for three- or four-week rotations during their summer break.
Currently, we have over 200 applicants to the program and we hope to be able to find a match for each applicant. The demand in the areas of Houston, Austin, San Antonio, and Dallas/Fort Worth is especially high. If you can make time in your busy schedule to sign up to take even one student, we can reach our goal.
Please note: to be eligible to serve as a preceptor, physicians must be:
Thank you for your time and dedication to the advancement of internal medicine in Texas!
Honor those individuals that have INSPIRED you, and they may join the prestigious group of individuals from Texas who have been recognized in the past with a National Award, or perhaps, as part of the class of 50 Texas Physicians who have been awarded the highest honor of being recognized as Masters of the College.
One of the goals of the American College of Physicians is to “recognize excellence and distinguished contributions to internal medicine.” As a way of achieving this goal, the College offers 23 national awards and a number of Masterships each year.
The Nominator supplies four letters of support (his or her nomination letter and three additional supporting letters) as well as the nominee’s curriculum vitae with complete bibliography via the online submission form. The Awards Committee reviews all nominees at their yearly meeting and scores each individually. The nominees with the highest scores are recommended as candidates for awards and Masterships to the Board of Regents. The Board of Regents reviews the candidates and, if found to represent the highest standards of the College, approves the candidates. Approved candidates are informed by their Governors and formally presented their awards and Masterships at the annual Internal Medicine meeting approximately six months later.
Nomination materials due for all other awards and Masterships — materials received after this date will be held for consideration in the following year’s cycle
Awards Committee selects recommended candidates; Board of Regents reviews/approves candidates
Announcements made on ACP Online and via message to all nominators
To view the list of your fellow TXACP Physicians recognized for excellence and distinguished contributions to internal medicine through the past years, please click here.
The Awards Committee is pleased to announce that the Board of Regents has approved the following individuals and institutions to receive College Masterships at Internal Medicine 2016.
Please join us in congratulating the new Masters.
Robert E. Jackson, MD, MACP
Lysbeth W. Miller, MD, MACP
If you would like to personally congratulate any of the new Masters, please contact Meghann Williams, Administrator, Awards Program, by e-mail at firstname.lastname@example.org, 800-523-1546, ext. 2714 or 215-351-2714.
You and your guest are invited to the
Texas ACP Chapter and Alumni Cocktail Reception
Friday, May 6th
6:30 - 7:30pm
Held in Conjunction with
ACP Internal Medicine 2016
Additional information to follow
Congratulations to all the Medical Students and Residents presenting at this year's Internal Medicine, May 3 - 7th, in Washington, DC. We are wishing them all the best of luck with their presentations. Please check our Facebook page prior to the meeting to find the competition locations so you may show them TXACP's support by cheering them on!
|Cheyenne M Mangold|
|Zoya F Moghal|
|Memon Humna Abio, MD||Serena M Okoronkwo, MD|
|John Allison, MD||Anam Omer, MD|
|Ryan Babcock, MD||Chhaya Patel, MD|
|Eugene Chaung, MD||Veena A Patel, MD|
|Erica Fidone, MD||Ryle Przybylowicz, MD|
|Brendan Gilmore, MD||Katherine B Salciccioli, MD|
|Andrew Hawrylak, MD||Susan Seago, MD|
|Rasheen Imtiaz, MD||Tasneam Shagroni, MD|
|Sonam Jaggi, MD||Anusha Thomas, MD|
|Fathima Z Kamil Faiz||Jeremy Walker, DO|
|Maryam Kaous, MD||Theresa N Wenker, MD|
|Daniel Kil, MD||Betty Yang, MD|
|Tasnim Lat, DO||Daniel Siao Zhang, MD|
|Fiorella Chea Llanos, MD|
|Michelle Janania Martinez, MD|
|Harsha V Mudrakola, MD|
Doctor's Dilemma Teams
|Representing Texas Northern||Representing Texas Southern|
|Scott & White Temple||Baylor Houston|
|Lauren Sisco, MD||Rohit Maini, MD|
|Tasnim Lat, MD||David Wong, MD|
|Kirill Lipatov, MD||Harsha Mudrakola, MD|
May 3 - 7th
There is still time to join ACP and thousands of your colleagues in Washington, DC, and transform the way you practice medicine. Internal Medicine 2016 is the only meeting of its kind—combining clinical skills workshops with over 200 scientific sessions to update your knowledge in all facets of internal medicine and the subspecialties.
Refresh your internal medicine knowledge, sharpen your practice management skills, and network with the best and brightest physicians from around the globe. All of this plus a variety of special events including a reception for International attendees make this a meeting not to be missed.
(in conjunction with Internal Medicine Meeting 2016)
May 3-4th, 2016
Westin Washington DC City Center
1400 M Street, NW
Washington, DC 20005
The 24th annual Leadership Day on Capitol Hill will be held on May 3 - 4, 2016 in conjunction with the Internal Medicine Meeting in Washington, D.C.
This two-day advocacy event is a great opportunity for the College and our members to increase our presence and bring visibility to issues of concern to Congress. As usual, there will be training sessions and briefings by congressional staff and key government officials and staff on Tuesday, May 3. Attendees will also receive a comprehensive orientation on ACP’s top legislative priorities. A special briefing for Residents/Fellows-in-training and medical students is also provided. Visits to Capitol Hill will take place on Wednesday, May 4.
This event is open to ACP members only. ACP members interested in participating in Leadership Day 2016 should contact The TXACP Business Office to let us know of your interest and to be included in the chapter delegation congressional meetings. Attendance is expected to be greater than usual due to the Internal Medicine meeting occurring that same week so please act early.
Make your Hotel Reservations
Tentative Schedule of Events
View Video of Leadership Day
Find Your Elected Officals
For more information, contact Shuan Tomlinson at email@example.com or (800) 338-2746 ext. 4547.
Ending the SGR and maintaining the ACA top the 'good news' list for 2015
The American College of Physicians -- and patients and doctors in general -- enjoyed some major legislative victories in 2015.
"We had quite a winning streak -- one of the best years we've had in a long, long time," said Bob Doherty, ACP's senior vice president for governmental affairs and public policy. "This Congress ended up being more productive than some of its predecessors. It passed legislation, reached an accord on the budget and managed to avoid any government shutdowns -- all of those things that Congress should have been doing all along."
Areas in which the federal government took action to support physicians and patients in the past year included:
Medicare Reimbursement System. Last spring, Congress finally snuffed out the much-disliked sustainable growth rate approach to Medicare reimbursement. In its place came a complex reimbursement system designed to lower costs and support high-quality health care.
The change means that the annual congressional battles over Medicare reimbursement are history, along with the accompanying uncertainty about whether physicians would get paid.
"A lot of people have forgotten about that," Doherty said, "but it was a really big deal, maybe the biggest legislative accomplishment for ACP and organized medicine in decades."
ACP still has work to do as the federal government works out the kinks of the new reimbursement system, but even so, the victory is still sweet, he said.
Health Care Coverage. Congress did pass a bill to repeal the Affordable Care Act, but President Obama vetoed it early this month. Ultimately, then, "Congress didn't do anything to substantially gut, defund or hurt the key coverage requirements of the Affordable Care Act," Doherty said. In addition, the Supreme Court in June confirmed the legality of the federal subsidies for insurance coverage, considered a cornerstone of the ACA.
Health Care Costs. Doherty also noted that Congress took action to rein in the cost of drugs and phase out higher payments for outpatient care offered by hospitals. Critics argue that these payments give hospitals an incentive to gobble up private practices. Congress also delayed until 2020 implementation of a tax on high-cost employer-sponsored health insurance plans.
Electronic Health Records. As part of its budget agreement, Congress gave the Centers for Medicare and Medicaid Services the authority to streamline the process for granting hardship exemptions so that doctors who treat Medicare and Medicaid patients would not be penalized for being unable to meet the reporting deadline on "meaningful use" of electronic records because the government published the rule too late. For 2015 alone, doctors can affirm their meaningful use of electronic records for any 90-day period. "We and the American Medical Association pushed Congress very hard to get legislative relief," Doherty said. "Right before they adjourned, they passed the legislation. That's a big, big win for us."
Advance Care Planning. Congress did not intervene to stop Medicare from paying for advance care planning as of this year. Doherty noted that that should end the battle over so-called death panels, with its misleading claims, and will enable physicians to be paid by Medicare for helping patients plan their final days, including discussions on living wills and advance directives.
The achievements of 2015, Doherty noted, came with a lot of hard work.
On the sustainable growth rate issue, for instance, "we just wore them out," he said. "They were so tired of having to deal with it every year and hear from physicians lobbying them. And we laid the groundwork for two years in a row when we brought forth consecutive ideas about how to get rid of the SGR and how to replace it. We came to the table with ideas about how to transfer to alternative payment models."
Despite the year's successes, "I don't think we're out of the woods," Doherty said. "We haven't entered a new year of bipartisan agreement."
And, there have been disappointments. The start of 2016 brought the end of 10 percent bonuses in Medicare reimbursements for primary care physicians. "Although there was a lot of interest in continuing the program among Republicans and Democrats alike," Doherty said, "it fell victim to several things, like the cost and the difficulty in getting Congress to spend more money on anything these days."
The initiative to reduce gun violence that ACP pushed for also didn't come about. Nor did federal funding get approved, as ACP had hoped, for a study into shortages in the primary care workforce.
But overall, Doherty said, 2015 brought plenty of good news.
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 new physicians to showcase their hard work locally at one of our five Residents regional competitions.
Host: UT Houston Health Science Center
Date: Saturday, April 30, 2016
Time: 10am - 5pm
Location: Memorial Hermann Hospital TMC Conference Center
Host: Texas Tech HSC-Internal Medicine Lubbock Campus
Date: Wednesday, April, 27 2016
Time: 6 - 8pm
Location: 3601 4th St, Room ACB240, TTUHSC-Internal Medicine
Host: Methodist Hospitals of Dallas
Date: Wednesday, May 18, 2016
Time: 5:30 - 8:30pm
Location: Methodist Dallas Medical Center
Host: Dell Medical | UT Austin
Date: Friday, May 13, 2016
Location: Dell Medical
Host: Texas Tech HSC- PLFSOM
Date: Wednesday May, 25 & Friday, May 27, 2016
Location: TTUHSC - El Paso, 4800 Alberta Ave, AEC Blg
June 9 - 10th, 2016
JW Marriott Houston
5150 Westheimer Road, Houston, TX 77056
The 2016 Texas Primary Care and Health Home Summit will be the fourth annual statewide conference focused specifically on expanding access to medical home for individuals and families in Texas. This Summit will offer stakeholders the opportunity to learn about medical home models and best practices, and to interact with program experts at various stages of implementation.
The goal of the Summit is to provide opportunities for participants to hear from practitioners that have been successful in making transformational changes to their practices. An overarching goal is to offer practical, tangible and useful tips and tools to help practices at all stages of their transformation.
This year’s Summit will to appeal to practices that are interested in learning about new models of primary care but that may not be quite ready to make the transition to becoming a health/medical home. In addition, this year’s Summit will include sessions on successful models in pediatric health homes as well as updates on the Medicaid 1115 waivers, direct primary care and value based care. We will once again offer a number of pre-summit sessions on Thursday morning for those that want to explore topics in greater depth. The Summit will include a greater focus on integration of behavioral health into the heath home as well as more content on health homes for children and adolescents.
For more information on this event please read more here.
In the meantime, please contact Stephanie Ondrias at firstname.lastname@example.org if you have any questions.
As a supplement to the formal education program that ACP offers in partnership the American Association for Physician Leadership, the ACP Leadership Academy offers a series of free online webinars on leadership topics relevant to internal medicine. These webinars provide both an educational experience and a discussion forum so that ACP members can learn, pose questions, and share ideas with leaders in the internal medicine field.
Registration is now open for the following upcoming webinar:
|Title:||Teaching Clinical Reasoning|
|Date/Time:||Tuesday, May 24, 2016, 3:00 p.m. ET|
|Speakers:||Robert L. Trowbridge, MD, FACP and
Joseph J. Rencic, MD, FACP
|Register:||Sign up online now|
View previous free ACP Leadership Academy webinars:
Fellowship recognizes personal integrity, superior competence in internal medicine, professional accomplishment, and demonstrated scholarship.
|Adesubomi B Agoro, MD FACP, Fort Worth||Jeong Oh, MD FACP, Sugar Land|
|S Murthy Badiga, MD FACP, Mc Allen||Charles O Olisa, MD FACP, Cedar Hill|
|Blake R Barker, MD FACP, Dallas||John Paredes, DO FACP, Hallsville|
|Terry Bowman McLendon, MD FACP, Houston||Gloria G Peralta, DO FACP, Arlington|
|Andria B Cardinalli-Stein, MD FACP, Tyler||Rebecca A Quiroz, MD FACP, San Antonio|
|Eduardo Enrique Chang, MD FACP, The Woodlands||Lokesh R Shahani, MBBS FACP, Houston|
|Joaquin G Cigarroa, Jr MD FACP, Laredo||Vickie R Shannon, MD FACP, Houston|
|Muttavancheril J George, MD FACP, Plano||Mai F Sharaf, MD FACP, Colleyville|
|Richard C Johnston, MD FACP, Irving||William B Snodgrass, MD FACP, Lubbock|
|Maria I Juarez, MD FACP, Duncanville||Abey K Thomas, MD FACP, Dallas|
|Wilson Lam, MD FACP, Houston||Sadie A Trammell Velasquez, MD FACP, San Antonio|
|Richard S Lawlis, MD FACP, Georgetown||James W Walton, DO FACP, Dallas|
|Esteban R Lopez, MD FACP, San Antonio||Larry A Warmoth, MD FACP, Wolfforth|
|Alecia Nero, MD FACP, Dallas||David D Weeks, MD FACP, Austin|
We are proud to welcome the following new members who have joined the Chapter during the last four months.
|Naureen I Agha, MBBS, Plano||Vernon Joseph Lawrence, Richmond|
|Ammar Alqaid, MD, Longview||Siva K Mandadi, MBBS, Tyler|
|Carlos N Casas Zaragoza, MD, Laredo||Victor M Martinez Soria, MD, San Antonio|
|Yixiao Chen, MD, Irving||Chanh M Nguyen, MD, Spring|
|Rita Corona, MD, Lubbock||Mehar C Oad, MD, Coppell|
|CAPT Panfilo Delacruz, MD, San Antonio||Yvonne Otieno, MD, Austin|
|Lenore C Depagter, DO, San Marcos||Jesus J Pimentel, MD, Houston|
|Jayne M Garcia, MD, Round Rock||Reshma Ramlal, MD, Houston|
|Laura E Garcia, MD, Palm Valley||Ramona Rhodes, MD, Dallas|
|Meghana Gore, MD, Sugar Land||Ismail Salejee, MD, Salado|
|Praveen K Guntipalli, MBBS, Wichita Falls||Lauren Tada, DO, Corpus Christi|
|MAJ Angel Guido Hita, MD, Cypress||Behyar Zoghi, MDPhD, San Antonio|
Jose G Diez, MD, has joined Baylor College of Medicine’s cardiology group, now known as Hall-Garcia Cardiology Associates at Baylor College of Medicine, a team of internationally recognized doctors. The team joined Baylor’s department of medicine – section of cardiology, building on its commitment to improving patient care. Read press release here.
Robert A Phillips, MD PhD FACP, the chief medical officer at Houston Methodist, will lead a study funded by the Health Policy Institute that will look at the problem of “readmission.” Read press release here.
UTRGV award $4.2 Million from THECB to expand Graduate Medical Eduction. Read 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.
Texas Chapter Annual Scientific Meeting
November 17-18, 2018, JW Marriott Austin
Book Your Hotel Now!