Texas Family Physician, Q1 2017 by Texas Academy of Family Physicians

TEXAS FAMILY PHYSICIAN VOL. 68 NO. 1 2017

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TEXAS FAMILY PHYSICIAN VOL. 68 NO. 1 2017

The servant leader

The Texas Family Physician of the Year for 2016-2017, Kaparaboyna Ashok Kumar, MD, FRCS, FAAFP, has been a mentor to hundreds. His passion for caring for his own patients is rivaled only by his passion for teaching medical students to care for theirs. Congratulations, Dr. Kumar.

6 FROM YOUR PRESIDENT An update on family medicine in the 85th Texas Legislature and how you can get involved 8 MEMBER NEWS Highlights from TAFP’s 2016 Annual Session and Primary Care Summit | Billings wins AAFP award | Members tapped for national positions | A big year for Hard Hats

By Kate Alfano

Medicare enrollment land mines

What if you could no longer accept Medicare patients? Let’s make sure that doesn’t happen. By Corinne Smith

On the border of health

A group of medical students from UTMB Galveston spent part of their winter break in Big Bend country, caring for families who don’t get to see many doctors. By Perdita Henry

14 PRACTICE MANAGEMENT Chronic Care Management requirements and benefits explained 24 FOUNDATION FOCUS Thank you to our 2016 TAFP Foundation donors 28 TAFPPAC Everything you ever wanted to know about the PAC, plus the 2016 TAFPPAC donors 30 TAFP PERSPECTIVE You’re invited to AAFP’s NCCL.

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PRESIDENT’S COLUMN

TEXAS FAMILY PHYSICIAN VOL. 68 NO. 1 2017 The Texas Academy of Family Physicians is the premier membership organization dedicated to uniting the family doctors of Texas through advocacy, education, and member services, and empowering them to provide a medical home for patients of all ages. TEXAS FAMILY PHYSICIAN is published quarterly by TAFP at 12012 Technology Blvd., Ste. 200, Austin, Texas 78727. Contact TFP at (512) 329-8666 or jnelson@tafp.org.

OFFICERS president

Tricia Elliott, MD Janet Hurley, MD

president-elect vice president

Javier “Jake” Margo, Jr., MD

treasurer

Rebecca Hart, MD

parliamentarian

Amer Shakil, MD

immediate past president

Ajay Gupta, MD

EDITORIAL STAFF managing editor

Jonathan L. Nelson

associate editors

Perdita Henry and Jean Klewitz chief executive officer and executive vice president

Tom Banning chief operating officer

Kathy McCarthy, CAE

advertising sales associate

Michael Conwell CONTRIBUTING EDITORS Kate Alfano Christina Kelly, MD Corinne Smith

SUBSCRIPTIONS To subscribe to TEXAS FAMILY PHYSICIAN, write to TAFP Department of Communications, 12012 Technology Blvd., Ste. 200, Austin, Texas 78727. Subscriptions are $20 per year. Articles published in TEXAS FAMILY PHYSICIAN represent the opinions of the authors and do not necessarily reflect the policy or views of the Texas Academy of Family Physicians. The editors reserve the right to review and to accept or reject commentary and advertising deemed inappropriate. Publication of an advertisement is not to be considered an endorsement by the Texas Academy of Family Physicians of the product or service involved. TEXAS FAMILY PHYSICIAN is printed by AIM Printing and Marketing, Austin, Texas. LEGISLATIVE ADVERTISING Articles in TEXAS FAMILY PHYSICIAN that mention TAFP’s position on state legislation are defined as “legislative advertising,” according to Texas Govt. Code Ann. §305.027. The person who contracts with the printer to publish the legislative advertising is Tom Banning, CEO, TAFP, 12012 Technology Blvd., Ste. 200, Austin, Texas 78727. © 2017 Texas Academy of Family Physicians POSTMASTER Send address changes to TEXAS FAMILY PHYSICIAN, 12012 Technology Blvd., Ste. 200, Austin, TX 78727. 6

TEXAS FAMILY PHYSICIAN [No. 1] 2017

A whirlwind start to a busy year By Tricia Elliott, MD TAFP President family physicians face every day, like prior greetings colleagues. Regardless of what authorizations, documentation guidelines you think about the first several weeks of 2017, for E/M services, and translation service you certainly can’t say they’ve been boring. costs. These and other regulatory hurdles With the inauguration of a new president drive up operating costs and erode the thin and the installation of his administration, the margins most family doctors depend on to uncertain future for the Affordable Care Act, keep their doors open. In a recent “In the and the start of the 85th Texas Legislature, we Trenches” blog post, AAFP Senior Vice Presihave a lot of big issues to keep up with. dent of Advocacy, Practice Advancement, and As it turns out, “repealing and replacPolicy, Shawn Martin, ing Obamacare” is much wrote that reducing these easier said than done and regulatory and adminisanyone who professes to Once again, trative hassles is a priority know how the president for the Academy. and Congress will pronurse practitioner “The AAFP is actively ceed most likely doesn’t. organizations advancing reforms with AAFP continues to be an have come to the both public and private influential resource to payers, but we also are policy makers in WashCapitol seeking the advocating for reducington D.C. In letters to authority to diagnose tions in burdens associPresident Trump and and treat patients ated with the licensure to the leadership of the and certification proHouse and the Senate, independently under cesses — both of which AAFP has defined its the supervision of have grown at a healthy priorities: health care only the Texas Board pace during the past for all, delivery system decade,” he wrote. and payment reform, of Nursing. We Meanwhile back at health care affordability, believe this further the ranch, the Texas Lega national health care fragments our already islature is in full swing workforce strategy that and your Academy is on promotes the value of fractured health the scene, promoting primary care, and the care delivery system policies that help family promotion of prevention without any evidence physicians continue to and wellness. provide their patients “The AAFP and its that such a move care. Texas more than 124,900 family would increase access excellent faces a budget shortphysicians and medito care for patients fall of about $6 billion cal student members are for the next two years, eager to partner with in underserved which means lawmakers you and your Adminiscommunities. will be scrutinizing protration to identify and grams for possible cuts implement policies that as they craft the state improve people’s lives budget for 2018 and 2019. through an accessible, high-quality, efficient, TAFP will work to protect policy gains and diverse health care system,” AAFP Presiwe’ve made over the past few sessions, like dent John Meigs, Jr., MD, wrote to then Presfunding for family medicine residency proident-elect Trump after the election. “I and grams, support for the Texas Family Mediour members stand ready to do the imporcine Preceptorship Program, and the Physitant and hard work necessary to achieve cian Education Loan Repayment Program. these goals.” We’re also advocating for legislation that Our Academy has also been pushwould help physicians offer their patients ing to reduce the administrative burdens

telemedicine services and receive payment for those services. And of course the Academy intends to protect the collaborative practice, teambased reforms the Legislature passed in 2013 when physicians, nurse practitioners, and physician assistants agreed to streamline the state’s scope-of-practice laws. Once again, nurse practitioner organizations have come to the Capitol seeking the authority to diagnose and treat patients independently under the supervision of only the Texas Board of Nursing. We believe this further fragments our already fractured health care delivery system without any evidence that such a move would increase access to care for patients in underserved communities. There are several ways you can help advocate for your specialty, your colleagues, and your patients, and you can find a handy list at www.tafp.org/advocacy/get-involved. Perhaps the most interesting way is to serve as Physician of the Day. Since 1971, TAFP has provided a family physician in the Capitol First Aid Clinic to treat anyone on the grounds each day the Legislature has been in session. As the Physician of the Day, you are introduced in both the Senate and the House of Representatives and your name becomes a permanent part of the official legislative record. You have an opportunity to meet your representatives and spend the day doing what you do best in one of the state’s most historic settings. I served as Physician of the Day on the first day of this session and I brought along a friend. Mercedes Giles, MD, a second-year family medicine resident at UTMB Galveston, joined me for the day and it was thrilling to be there with her as we showed our elected officials what two family physicians really look like! There are still a few spots available if you’d like to participate. Just go to the advocacy section of TAFP.org and click on the Physician of the Day link. TAFP and AAFP serve as our voice, speaking for family medicine in the State Capitol and on the Hill. We have a strong team of advocates with great relationships across state and federal agencies and with our legislators. In these times of great change, our Academy continues to make strides in support of our patients and our practices. But we couldn’t do it without you, so go to TAFP.org and explore how you can get involved.

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MEMBER NEWS

Highlights from TAFP’s Annual Session • November 2-4, 2016 The committees, commissions and sections of the Texas Academy of Family Physicians met in Dallas and deliberated on many important items. Thanks to all the members who participated. Most commissions, committees and all sections are open to guests and meet twice a year at TAFP’s Interim and Annual Sessions. You can also request an appointment by submitting a “Make Your Mark” involvement form. Contact Juleah Williams at jwilliams@tafp.org with any questions. Here are a few of the highlights of the recent meeting. All the recommendations mentioned will be presented to the Board of Directors.

ADVOCATING FOR YOU AND YOUR PATIENTS There was extensive discussion during the meeting about MACRA. The final rules were released in October 2016. The Commission on Health Care Services and others reviewed resources available for members on the AAFP and TAFP websites. The Commission on Health Care Services heard a presentation on the implementation of the Chronic Care Management codes for Medicare patients from Innovista. They also discussed a proposal that the Board ultimately adopted to host two events with employers in metropolitan areas to spark discussion around innovative ways they can provide health benefits to their employees. The Commission on Legislative and Public Affairs discussed issues likely to be addressed during the next legislative session including telemedicine, 1115 reauthorization and a potential Medicaid block grant, mandated use of the prescription drug monitoring program, and sunset of the Texas Medical Board. Members are encouraged to participate in the Key Contact Program, contribute to TAFPPAC, and serve as Physician of the Day. WORKFORCE DEVELOPMENT The Commission on Academic Affairs discussed the Texas Family Medicine Preceptorship Program. Funding for the program was restored for 2016 primarily for stipends for students. The number of preceptorships 8

increased and the commission members proposed ideas to improve the program going forward. The goal of the program is to provide an opportunity for first- and second-year medical students to experience family medicine outside the academic health center. Practicing physicians are needed to volunteer to serve as preceptors and medical students are encouraged to apply for the program. Stipends are available for students. The commission also discussed ways that local chapters can help encourage medical students to seek out the various funding opportunities and scholarships available through the TAFP Foundation. The board of directors approved two new projects for the coming year. The first is to develop a video in 2017 to encourage medical students to consider family medicine. The second is to begin developing online curriculum in practice management that can be used by residency programs to satisfy their requirements. MEMBER SERVICES AND RESOURCES IN DEVELOPMENT The board approved a proposal that had the support of the Commission on Membership and Member Services and the Commission on Continuing Medical Education to provide one free registration for early career physicians. Active members in their first two years out of residency will be able to take advantage of a complimentary general session registration for one of TAFP’s live CME events beginning in 2017.

TEXAS FAMILY PHYSICIAN [No. 1] 2017

The Leadership Development Committee met to review the first year of the Family Medicine Leadership Experience and shape the curriculum for the 2017 class. The new class will have their first session during TAFP’s Interim Session in April. TAFP Member Communities were launched at Annual Session. Members attending the meeting could meet and engage in discussion. The two communities were for Early Career Physicians and Solo and Small Group Physicians. They were well-received and more opportunities will be made available in the future for members to connect and learn from each other. TAFP is an ACCME-accredited provider of continuing medical education and has maintained that status since 1996. Staff and volunteers collaborate to plan and produce education for members and ensure compliance with all requirements. At Annual Session, the Commission on Continuing Professional Development and the CME planning committee worked on future educational offerings and discussed the changes to ABFM’s Maintenance of Certification. They also discussed introducing different educational delivery mechanisms like small group discussion into TAFP CME events in the future. PUBLIC HEALTH AND RESEARCH The Commission on Public Health, Clinical Affairs, and Research had guest speakers on HPV immunization rates in Texas, the Healthy South Texas Initiative, and the Texas Women’s Healthcare Coalition. TAFP meetings are an opportunity to gather and participate in discussion on a variety of topics. Section meetings are held at TAFP’s Interim and Annual Sessions on maternity care, rural health, and research and they are intended for any member to show up and participate. The Section on Research was just formed a few years ago and is trying to generate momentum and interest. They reviewed a portion of the TAFP.org site focused on

research and made suggestions for improvements. ORGANIZATIONAL ISSUES The Nominating Committee had a discussion that resulted in a recommendation to begin the process of modifying the board structure. The Bylaws Committee will start making the necessary changes to eliminate the vice president position and have two at-large directors elected each year for two-year terms rather than the current structure in which one director is elected each year for a three-year term. The total size of the Board of Directors will remain the same. The voting representatives on the Member Assembly elected these 2016-17 leaders: President-elect: Janet Hurley, MD Vice President: Javier “Jake” Margo, Jr., MD Treasurer: Rebecca Hart, MD Parliamentarian: Amer Shakil, MD Delegate to AAFP: Douglas Curran, MD Alternate Delegate to AAFP: Troy Fiesinger, MD; Ashok Kumar, MD New Physician Director: Ike Okwuwa, MD At-large Director: Emily Briggs, MD Special Constituencies Director: Mary Nguyen, MD Resident Director: Samuel Mathis, MD Medical Student Director: Carissa Huq At the Annual Business and Awards Luncheon, the membership approved bylaws amendments recommended and published in Texas Family Physician last year. These changes were meant to clarify the voting status of student members, the process for submitting resolutions to the Board of Directors, the nomination process, to consolidate the definition of the composition of the Member Assembly, and redefine the term of office for TAFP’s Delegates and Alternates to the AAFP Congress of Delegates.

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MEMBER NEWS

COMING SOON ON TAFP’S

CME SCHEDULE C. Frank Webber Lectureship & Interim Session April 7-8, 2017 Renaissance Austin Hotel Austin, Texas Texas Family Medicine Symposium June 2-4, 2017 La Cantera Hill Country Resort & Spa San Antonio, Texas Annual Session & Primary Care Summit Nov. 10-12, 2017 Nov. 8-9: Business meetings and preconference workshops

Galveston Island Convention Center, The San Luis Resort, and Hilton Galveston Island 10

TEXAS FAMILY PHYSICIAN [No. 1] 2017

Billings wins AAFP Exemplary Teaching Award Adrian Billings, MD, PhD, of Alpine, was awarded the Exemplary Teaching Award by the American Academy Family Physicians. This award honors individuals who’ve made outstanding contributions to family medicine through teaching. Billings is an associate professor at Texas Tech University Health Sciences Center School of Adrian Billings, MD, PhD Medicine, clinical assistant professor at the University of Texas Medical Branch, and Chief Medical Officer of Presidio County Health Services. His notable work with Texas Tech University Health Sciences Center Family Medicine Residency to establish the first rural training program on the United States-Mexico border has brought medical access to the underserved area. A long-time

preceptor in the Texas Family Medicine Preceptorship Program, who has mentored over 100 medical students, Billings became the program director in 2015. Originally from Del Rio, Texas, Billings received a Bachelor of Science from Texas A&M University, obtained his Doctorate in Philosophy in Experimental Pathology and Medicine from the University of Texas Medical Branch, and earned his medical doctorate from the University of Texas Medical Branch. Prior to entering medical school, Dr. Billings completed a post doctorate program at the Center for Disease Control. He completed his family medicine residency at John Peter Smith Hospital where he was also Chief Resident. While reflecting on his work with medical students, Billings stated, “I feel that my most important work in my everyday professional life is precepting these medical students and residents because I hope they will find an undiscovered passion for the care of vulnerable, underserved rural patients.”

Members tapped for national positions Ike Okwuwa, MD, FAAFP, of Odessa, was recently appointed to AAFP’s Commission on Membership and Member Services. Okwuwa is currently the assistant dean for clinical affairs at Texas Tech University Health Sciences Center Permian Basin, serves on the board of the Permian Basin Healthcare Network, and is co-medical director at the Northeast Volunteer Fire Department. He serves on the TAFP Board of Directors and he is a member

of the Commission on Continuing Professional Development and the Commission on Academic Affairs. Samuel Mathis, MD, of Stafford, was named AAFP Resident Delegate to the American Medical Association’s Resident and Fellow Section. Mathis is currently serving as Resident Physician on TAFP’s Board of Directors and as TAFP’s Alternate Delegate to AAFP’s Resident Assembly.

Hard Hats for Little Heads closes 2016 with a bang 2016 was a great year for Hard Hats for Little Heads. Not only did the number of family doctors participating in the program increase, more than 3,000 kids were fitted for brandnew bike helmets, and they got to spend time with their local family docs. Our continued partnership with the Texas Medical Association facilitates opportunities for doctors to interact with children all over Texas by teaching them the importance of keeping themselves safe.

As we head into the new year, we hope you’ll be inspired to hold a Hard Hats for Little Heads event in your town. There are still counties who have not sponsored an event. Our goal is to see every nook and cranny of Texas holding events to show their community that family docs care for kids. If you are interested in holding a Hard Hats for Little Heads event, contact Texas Medical Association Outreach Coordinator, Tammy Wishard at tammy.wishard@texmed.org.

RISK MANAGEMENT

Enrollment land mines: Revocation of Medicare billing privileges By Corinne Smith, Strasburger and Price

hat would happen to you or your practice if your Medicare privileges were revoked? For many physician practices, this would essentially be a death penalty and their practice would have to shutter its doors. Despite the dire consequences related to mistakes in Medicare provider enrollment, many physicians are unaware of the provider enrollment rules and fail to update their Medicare enrollment information. Are you at risk? The answer may depend on when you last reviewed your Medicare provider enrollment status, if ever. The Center for Medicare Services has recently initiated a significant process related to revalidation of provider enrollments, audits of physician enrollments and, as a result, is issuing harsh penalties for non-compliance. With the increased scrutiny on physician practices, it is important that you have a comprehensive understanding of the rules and know how to respond to any action by CMS. All physicians and practices must enroll with Medicare in order to obtain a billing number. This is usually accomplished by completing the CMS 855B form. This is a paper form that is still available even though Medicare moved to the Internet-based electronic system Provider Enrollment, Chain and Ownership System, or “PECOS”, several years ago. To maintain Medicare billing privileges, you must resubmit and recertify the accuracy of your individual and/or group Medicare enrollments every five years. You must also notify Medicare of changes to your practice when they occur.

Why is this happening? CMS announced these audits and the expansion of its exclusion authority as part of a fraud fighting expansion. CMS can and will revoke or deny enrollment to physicians who do not comply with Medicare regulations. The fraud is not just focused on physicians who have a “pattern and practice” of submitting improper claims, even though these are the physicians who pose a program integrity risk to Medicare. To identify incorrect practice locations, CMS has implemented a site visit verification process using a National Site Visit Contractor. The NSVC will verify enrollment-related information during the site visit and collect specific information based on pre-defined checklists. Failure to cooperate with inspectors could result in the denial or revocation of your Medicare

Does your practice have a compliance plan? The Office of Inspector General issued practice guidance on compliance requirements several years ago. The existence of a compliance plan can be helpful in the event of a CMS audit or allegation of wrongdoing. If your compliance program does not include periodic claims reviews and reviews of enrollment data for accuracy, now would be the time to update your practice’s compliance plan to include these activities.

The federal government recently ran an analysis of practice locations on Medicare enrollment against other data sources — U.S. Post office, state medical boards, and Social Security — and identified that 105,234, approximately 11 percent, of the listed physician practice location addresses were either vacant or contained an invalid address. You cannot use a post office box number as a practice location! If the error is determined by CMS before a contractor site visit occurs, CMS may send a notice letter and provide the practice an opportunity to correct the error. If CMS or one of its contractors visits your practice location and finds it is no longer being used, or is a post office

box, but the practice location is still on your Medicare enrollment, your Medicare billing privileges will be revoked.

enrollment number. In addition to the site validation, the contractor will look for minimal inadvertent claim errors, which can also result in revocation of billing privileges. CMS has confirmed that as few as three claims errors could indicate a “pattern or practice” of fraud. Physicians and physician groups are currently having their billing privileges revoked for inadvertent errors in claims, such as a few unrelated claims submitted under the provider number, without a modifier or for a person who is deceased. Sometimes the claims errors account for less than one percent of the total claims for the audit period but are still used against the physician and considered indicia of fraud. www.tafp.org

much quicker than a request for reconsideration. Filing a CAP provides the opportunity to “correct” the deficiencies that resulted in the denial or revocation. In situations when the enrollment denial or revocation of billing privileges was not warranted, it is important that the CAP provide objective evidence demonstrating compliance with the enrollment rules. This requires not only a thorough knowledge of the enrollment requirements, but may also require detailed information regarding past enrollment application filings. Second, to Currently, CMS has been focusing audits on provider practice maintain your appeal rights, you must file an locations as reported on the 855B. The audits have identified two official request for reconsideration within 60 major risk issues for physicians: (i) incorrectly identifying a post days of receiving a revocation notice letter. office box or home address as a practice location; and (ii) failing The request for reconsideration is a more formal document and must include all of the to make a timely report about a change in location, additional evidence substantiating your response. Be practice locations, closing of practice locations, etc. Many forewarned however, that filing a CAP is NOT physicians are unaware that they only have 30 days to report the same as filing a request for reconsiderachanges such as the relocation of an office, changes in billing tion and WON’T preserve your appeal rights. companies, or adding physicians to a group. Others simply One strategy that is often employed is to file a CAP, and if you don’t receive a decision “forget” to update their Medicare enrollment or don’t even know within 60 days, proceed with filing a request it is required. Failure to update your information could result in for a reconsideration. What do you do if you receive a letter informing you that your Medicare billing privileges have been or will be revoked? First, stop billing Medicare immediately. Generally, a revocation of billing privileges is effective 30 days after the written notice is mailed. However in many cases, CMS has imposed the revocation with a retroactive date. This finding results in a period of

your Medicare billing provider status revoked and bar you from re-enrollment in the program for up to three years.

non-compliance where the physician improperly billed, and received Medicare while the billing privileges were revoked. If the revocation is upheld, any Medicare collections during the period of “non-compliance” are considered overpayments and will result in a repayment obligation with possible penalties.

If a provider loses at reconsideration, there is a final option which is to appeal the decision to an Administrative Law Judge with the Department of Health and Human Services, Departmental Appeals Board. DAB appeals have specific procedural and evidentiary regulations, one of which states that a provider will not be permitted to submit new documentary evidence at the DAB level of appeal absent a showing of good cause. What this rule means is that you can submit all the testimony they like with a DAB appeal, but you generally won’t be permitted to submit any new evidence that was not submitted at reconsideration. For

If the letter is providing warning or an advanced notice, physicians and suppliers should complete and file a corrective action plan. The CAP must be submitted within 30 days for all other suppliers and physicians. The CAP requires that you update the enrollment and correct Is this really a big deal? It was just a mistake. Some of you may be any errors. In addition, the provider should thinking, how much could revocation really affect me? If it is an file an explanation and any other remedial innocent error, shouldn’t I be able to fix it relatively easily? The or prospective action regarding complishort answers to those questions are (1) it will affect you a lot; and ance. If the CMS contractor finds that (2) no it is not easy to fix. If you receive a letter from CMS or from the CAP contains sufficient evidence to Novitas, the local Medicare Administrative Contractor, notifying determine the provider or supplier is now in compliance with the Medicare requireyou of a revocation, or potential revocation, do not delay in acting! ments, billing privileges may be reinstated. There are quick deadlines requested for your response. If the CAP Payment would be made for services billed or letter of request for consideration are denied, there are further from the date of the reinstatement.

remedies for appeal or suit in district court. However, even with the best legal counsel, there is no guarantee that the appeals will be successful and that billing privileges will be reinstated.

If you receive a letter indicating your privileges have already been revoked, you must file a request for reconsideration, usually within 60 days. The request must identify the error which resulted in the revocation and provide evidence as to why the finding was incorrect and why privileges should be reinstated. You should file a CAP within 30 days and a request for reconsideration within 60 days of the receipt of the letter. CAPS are usually reviewed quickly. Reconsiderations can take up to 90 days for review. Federal regulations give most physicians the opportunity to file a CAP within 30 days of receiving notice of Medicare revocation. A CAP can result in a reversal of a termination 12

TEXAS FAMILY PHYSICIAN [No. 1] 2017

this reason, it is very important that you carefully and thoroughly collect and submit all the documents relevant to your defense at the time of the reconsideration request. Assistance from experienced legal counsel with identifying those documents and developing legal arguments will be invaluable at this stage. As you can see, Medicare billing privilege revocations have serious consequences. If your billing privileges are revoked,

you will also be barred from re-enrolling for a period of one to three years. While loss of Medicare billing privileges may not be harmful to certain physician practices, there are additional ramifications to consider. If you lose Medicare billing privileges, Medicaid, CHAMPUS and other federal payors will also revoke billing privileges. There is also a significant risk that commercial payers will terminate you from their networks if you no longer participate in Medicare. If you take call at a local hospital, you will need to tell the hospital that you are no longer enrolled with Medicare. Thus, the collateral damages associated with a Medicare billing privilege revocation are significant. Now that you know all of the bad news, what can you do to stay out of trouble? First, if you don’t already have one, obtain a log-in to the PECOS system so that you can verify your enrollment and make changes in real-time. To validate or update your Medicare enrollment, you should use PECOS or fill out the paper forms 855B, for physician groups, and/or 855I for individual providers. There are significant advantages in using PECOS: (i) the turnaround time is shorter; (ii) you have more control over enrollment information including reassignments; (iii) it is easy to check and update your information for accuracy; and (iv) it takes less staff time and reduced administrative costs to complete and submit enrollment to Medicare. With the penalties associated with revocation being so high, it is very important to be aware of the ever-changing Medicare rules and remain in compliance. Remember you have only 30 days to notify Medicare when there are: (i) any changes in ownership; (ii) any changes in practice location; and/or (iii) any final adverse actions taken by Medicare. You have 90 days to notify Medicare of: (i) a change in practice status; (ii) a change in business structure, legal business name or taxpayer identification number; (iii) change in banking arrangements or payment information; and/or (iv) a change in the correspondence for special payments address. Check your status with PECOS today and frequently. If you already have a log-in for the National Plan and Provider Enrollment System for your National Provider Identifier, you may use that same log-in for PECOS. If you have forgotten your NPPES user name or password, you may contact the NPI Enumerator at (800) 465-3203 or customerservice@npienumerator.com to obtain log-in information. Don’t forget to update your NPI information with NPPES Registry while you are at it. Your information in PECOS and NPPES must match. Finally, be careful to whom you delegate access to perform these vital functions. Blaming the mistake on a billing company or employee is not going to be a sufficient defense in any Medicare appeal you are personally responsible for the accuracy of your information. In the end, it is your livelihood at stake and the ramifications from mistakes are draconian.

Corinne Smith, partner in Strasburger & Price LLP’s Austin office, advises health care providers about complex health care transactions, regulatory matters, and reimbursement. Prior to joining Strasburger she served as in-house counsel for Seton Health care Family and UT Medicine San Antonio/UT Health Science Center San Antonio. She is also a former health care administrator and Fellow in the American College of Healthcare Executives.

Keep good records and proof of filing. When you file any documents with CMS or the MAC, ALWAYS USE A TRACKING SERVICE (CERTIFIED MAIL OR FED EX) TO PROVE YOU FILED IT! If you don’t have a record of timely filing, your CAP or reconsideration can be denied without recourse. Likewise, if you are using paper forms instead of PECOS, you must keep excellent records and a proof of delivery. If you can’t prove you filed it, according to CMS, you didn’t file it.

What is re-validation? In February of 2016, CMS issued a Med Learn Matter (SE1605) concerning a new process for “re-validation” which was authorized under Section 6401 (a) of the Affordable Care Act. Providers should check the Medicare Revalidation website, http://go.cms.gov/MedicareRevalidation, to identify the due date for their validation. CMS encourages you to submit your re-validation SIX months before the due date or when you receive notification from your Medicare Administration Carrier. If you practice in Texas, your MAC is Novitas. Due dates are listed up to six months in advance and updated every 60 days. If the site says TBD, your due date is to be determined and you need to check back in 60 days or rely on the MAC to send you the re-validation notice. You will note that the advice to file the re-validation six months in advance doesn’t really work if the MAC gives you only two to three months’ notice of your due date. In fact, the Medlearn Matter states that if you are within two months of the due date and have not received notice to revalidate from the MAC, it is your responsibility to submit your revalidation application. If you are part of a large group – more than 200 providers – accepting reassigned benefits from providers or suppliers, the MAC will send you a spreadsheet and have dedicated provider enrollment staff to assist with large group revalidations. Failure to submit a timely revalidation application can result in deactivation of Medicare enrollment so the significance of the revalidation process cannot be overstated. If you are deactivated for a substantial period of time, your reactivation date will not be retrospective and there will be an interruption in billing and a loss in revenue. www.tafp.org

PRACTICE MANAGEMENT

CHRONIC CARE MANAGEMENT REQUIREMENTS AND BENEFITS MONTHLY REIMBURSEMENT • ONE BILLING CODE • FREE, DIRECT ASSISTANCE WITH PROCESS By TMF Quality Innovation Network

id you know there is an easier way to treat patients with two or more chronic conditions and receive reimbursement for doing so? The Centers for Medicare and Medicaid Services introduced a non-visit-based payment code for Chronic Care Management, or CCM, services on January 1, 2015. The billing code for CCM services is Current Procedural Terminology code 99490: “Chronic care management services, at least 20 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month.” Practitioners offering CCM may bill Medicare every 30 days for non-face-to-face care coordination services. This CPT code pays approximately $42 per month, depending on regional differences in reimbursement amounts. Please type the following URL into your web browser to take you to the CCM webpage where you will find a revenue calculator that you can download and into which you can input your data and have it automatically estimate your reimbursement: www.tmfqin.org/Networks/Chronic-CareManagement. The TMF Quality Innovation Network Quality Improvement Organization has created an online Chronic Care Management Learning and Action Network to help physicians and clinicians successfully adopt CCM into their everyday workflow and processes. Go to www.tmfqin.org/Networks/Chronic-Care-Management to access the CCM webpage where you will find a useful CCM Process Checklist that you can download and use to guide you through the process and keep track of action items. It also includes links to other useful tools to complete specific process requirements. 14

TEXAS FAMILY PHYSICIAN [No. 1] 2017

Below is more information about what physicians and clinicians need to do to implement these services and be reimbursed. Requirements — The following elements must be met for a physician or clinician to receive reimbursement. • Patients have access to care management services 24/7. • Patients receive continuity of care so that they are able to get successive routine appointments with a designated provider or care team member. • Care management is provided for chronic conditions that include: › assessment of a patient’s medical, functional, and psychosocial needs through either an initial preventive physical exam or a comprehensive evaluation and management visit; › timely receipt of all recommended preventive care; › patient’s medication is reconciled; › and there is oversight of patient selfmanagement of medication. • Development of a patient-centered care plan that includes the patient’s choices. › The care plan is based on a physical, mental, cognitive, psychosocial, functional and environmental assessment. › A copy of the care plan is provided to patients. • Care transitions between providers and care settings is managed. • Services provided by home- and community-based clinical service providers is coordinated. • Patients and caregivers can communicate with the provider by phone or using other electronic methods for non-faceto-face consultation.

• The care plan is electronic and is available 24/7 to all providers furnishing care to the patient. Benefits — By working with the TMF QIN-QIO, physicians and clinicians can easily implement CCM services into their workflow. There is only one billing code, and the CPT code pays approximately $42 per month. The TMF QIN-QIO will provide the following additional benefits to physicians and clinicians who are members of the Chronic Care Management LAN. • Assist clinicians by analyzing the characteristics of their Medicare FFS patients to determine which patients would be the most likely to benefit from CCM and document the frequency of CCM services in the patient’s care plan. • Assist practitioners to incorporate care plans into their electronic health record and billing systems. • Educate practitioners on setting up workflow processes, billing requirements, identifying clinical staff to deliver CCM services, enrolling patients in CCM EHR documentation, using telehealth and conducting educational webinars on CCM. • Identify and develop tools needed for practitioners to implement CCM, such as information for patients; consent forms; care planning documents; comprehensive care plans; contact tracking logs to manage, track, and document activities for patients who are receiving CCM services; and train practitioners and office staff on the use of this template. • Provide access to a CCM webpage that contains useful links to resources, tools and educational events, including an online discussion forum for practitioners and other clinical staff interested in and/ or implementing CCM. • Provide practitioners with periodic reports tracking hospital admissions, readmissions and emergency department use for their patients enrolled in CCM. Join the Chronic Care Management Network — Additional information about the TMF QIN-QIO’s Chronic Care Management Program as well as free online tools, resources and upcoming educational events are available on the TMF QIN-QIO website. To join, go to www.tmfqin.org/ and locate Chronic Care Management under the Networks tab.

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12/17/14 6:18 PM

Servant leader Kaparaboyna Ashok Kumar, MD 2016 TAFP Family Physician of the Year

Any family physician who has trained or practiced in Texas over the past two decades has most likely been positively affected — directly or indirectly — by Kaparaboyna Ashok Kumar, MD, FRCS, FAAFP, the 2016 TAFP Family Physician of the Year, through his service to medical education, patient care and community, and organized medicine. As a distinguished teaching professor of family and community medicine at the University of Texas Health Science Center at San Antonio and vice-chair of medical education and clerkship director for their Department of Family Medicine, Kumar teaches 220 medical students and 39 residents each year. He also sees patients in clinic, and has served on countless committees and in leadership positions for the Bexar County Medical Society, Texas Academy of Family Physicians, American Academy of Family Physicians, Texas Medical Association, and Society of Teachers of Family Medicine. But it isn’t his extensive resume that makes this physician shine; it is his servant heart, his gentle manner, his extensive medical knowledge, and his ready willingness to share his time with others. 16

TEXAS FAMILY PHYSICIAN [No. 1] 2017

JONATHAN NELSON

By Kate Alfano

Several of Dr. Kumar’s students congratulate him on being named Family Physician of the Year. From left: Courtney Widjaja, Charles Huynh, Sruti Nuthalapati, Jennifer La, K. Ashok Kumar, Hilary Hopkins, Preeti Singhal, Akshay Goswami, and Angel Su

www.tafp.org

K. Ashok Kumar demonstrates an examination for his medical students with one of his long-time patients, Lisa Villard.

umar grew up in Narsampet, a small town of roughly 10,000 people in the southern Indian state of Telangana. His father left his job as a manager for a textile mill to become a “freedom fighter,” a community leader who, among other things, brought medical services to the town in the years after India’s independence from British rule. Along with his mother, sister and four brothers, Kumar witnessed his father’s selfless service firsthand and it made a deep impression. “I learned the joys of community service from my father, starting in my childhood,” Kumar says. Kumar’s father was well educated and spoke English and Urdu, the local official language. The townsfolk would come to him to write letters for them or memos for an appeal. Their home served as the hub for community programs like BCG and cholera mass immunizations, and Kumar’s father advocated for public programs to provide a safe water supply and electricity for their town. “This community service inspired me,” Kumar says. “It came naturally for me to help people. At 7 or 8 years old I thought, ‘I need to be a physician, I want to help people,’ and then I worked toward it.” Kumar received his education through the high school level in Narsampet, where classes and textbooks were in his mother tongue of Telugu, then he prepared for the Medical College Entrance Test in English. He competed with upwards of 10,000 applicants for 150 medical school spots for the whole state of Telangana. As a small-town boy he was at a disadvantage as many students from bigger cities were educated at English-medium schools and were more fluent in the lan-

TEXAS FAMILY PHYSICIAN [No. 1] 2017

guage — but he received top marks on the test and was the only student from his class to be admitted to medical school. The school, Osmania Medical College Institute of Medical Sciences, is located in Hyderabad, the capital of Telangana and a huge city with a current-day population roughly five times larger than San Antonio and three times that of Houston. Though only 120 miles from Kumar’s hometown, the journey at that time required many hours of travel over three buses. He spent six years there: one year of advanced sciences and five years of medical coursework. Though the big city was intimidating, Kumar — a natural “people person” — quickly made friends and excelled in classes. He also continued his tradition of service by coordinating immunization camps in remote areas of the state that could only be traversed most of the way by jeep and the remainder by bicycle. And in his fourth year, he convinced the school’s dean to loan him and his peers the college bus to bring health education to nearby towns that were accessible by road. Influenced by his professors and the desire to practice medicine and operate, which he knew would enable him to treat more patients, Kumar pursued surgery. And as many of his professors received their higher medical education in England, Kumar sought out and completed a surgical residency at St. James University Hospital in Leeds. After completing the necessary training and passing his examinations, he was elected as a fellow to the Royal College of Surgeons, one of the highest honors. “That’s what most of my professors did so I wanted that, and that’s what I did.”

JONATHAN NELSON

It’s not just the patients that respond to Kumar’s disposition. Staff During his surgical residency he met his wife, Elaine, and they wrote in nomination letters that the clinic “buzzes with positive considered where to start their life together after training. Though he energy and cheerfulness when Dr. Kumar is around” and “he leads by considered returning to India to work and teach in a medical school, example, showing both patients and colleagues what it means to prothe couple ultimately decided to explore opportunities in America. As vide quality care.” an international medical graduate, Kumar had to go through residency The UTHSCSA patient population is diverse and, in line with the training all over again and was advised by friends to seek out the shortschool’s educational mission, the physicians and learners treat comest residency possible to learn the American health care system. One plex and underserved patients. But Kumar says there is little difference of his American friends in England recommended moving to Tyler, between small-town and big-city patients: they all just want a physiTexas, “because it’s a nice, small town where you can bring up children cian who will care for them and really pay attention. safely.” The University of Texas Health Science Center at Tyler had “I tell my students, and also it is true in my life, that I have pracone residency program at the time — family medicine — and northticed in different cultures and difeast Texas is where they landed. “The ferent languages, but it’s that caring connection to small-town people is attitude and concern that transcends in my blood,” Kumar says. all barriers: barriers of language and Following his family medicine culture and nationality and color,” residency, Kumar and his growing Kumar says. “Different cultures family were recruited to the tiny and accents, it doesn’t matter; my town of Hugo, Oklahoma, which patients see that I respect them and had no surgeon, to open a private want to help them.” practice for family medicine and “A lot of my patients don’t shake surgery. “It didn’t take too long hands with me, they only hug me — to establish myself as a physician even if I extend my hand,” he says. because everyone knows everybody “My secret is I just want my patient in a small town and word traveled to leave my exam room or my office fast.” Patients loved his style of with a smile on their face. That’s medicine. “What I do is listen to what I work toward because then them and give them the time they I know that they’re satisfied. They need. When they get a doctor who know how much we care about them talks to them and listens to them, and generally they do leave that way.” they really cherish it.” Intertwined with all of his years About four years went by and, in patient care and teaching are though he cared deeply for his two more elements that support his patients and they for him, Kumar felt dedication to medical education, a pull to teaching. “I knew I could the specialty of family medicine and serve the Hugo population of 5,000 his patients: leadership in organized for the rest of my life but to make medicine and community service. a bigger impact, I thought I could “Why I get involved [in organized mentor many students and resimedicine] is we have to work toward dents who could carry on my kind better medicine and better patient of medicine: how we need to care for care,” Kumar says. “All these changes patients at the bedside, with a trustare happening and the only way we ing relationship, treating them like can protect the doctor-patient relayour family.” – Kathy McCarthy, CAE tionship, the only way we can advoHe joined the faculty at his TAFP Chief Operating Officer cate for our patients, is if we take the former residency program in Tyler, lead. Not all of the doctors are doing teaching 20 students a year from UT it. I can do some changes in the exam Southwestern Medical School who room every day to make my patients rotated through the family medicine feel special, but at the same time there are things we can do as a comclerkship, and training roughly the same number of family medicine munity of doctors.” residents. After about seven years, though, he looked for a larger proKumar first became involved in TAFP in 1997 when he attended gram and he found a home at UTHSCSA. the Annual Leadership Forum and the National Conference of ConKumar feels strongly that physician-educators must guide students stituency Leaders. He was the first international medical graduate deland residents beyond the science curriculum to also learn about comegate to the AAFP Congress of Delegates and the first IMG member of munication, interpersonal relationships, and compassion — the art the TAFP Board of Directors. He moved through the ranks as a TAFP of healing versus just curing. “We have to be healers in addition to officer, ultimately serving as president in 2009-2010. During his presihaving all the scientific knowledge and technology, which is all very dency, he took on the challenge of increasing medical student interest important. I tell my students all the time: The machines attached to in family medicine and increasing both student and resident membera patient are doing all they can but they can never replace a nurse or ship in the Academy. He visited every medical school’s Family Media doctor. Patient care is only as good as the people looking at those cine Interest Group and every family medicine residency program in machines, not the machines themselves.”

“What sets him apart is his ability to bring fresh voices into TAFP and AAFP and encourage their growth and development. He never hesitates to encourage a student, resident, or colleague to get more involved with TAFP, to run for a position at the National Conference of Constituency Leaders, or to participate in a committee meeting. He makes our organization stronger with this aspect of his leadership and service.”

www.tafp.org

Many of the nurses who practice with Dr. Kumar congratulate him on winning the award. From left: Sasha Rios, Margaret Aguilar, Crystal Cruz, Melissa Reyes, April Bernal, K. Ashok Kumar, Maghan Rios, Beatriz Padilla, Veronica Mejia, Kaye Jajou.

Within his community he is active in Tar Wars, which aims to the state and challenged all TAFP members to mentor a young student reduce tobacco use in youth through educational programs in schools; and to encourage them to pursue family medicine. and Hard Hats for Little Heads, which provides education and free TAFP Chief Operating Officer Kathy McCarthy, CAE, has worked bicycle helmets to kids for head with Kumar for more than 15 years. injury prevention. He is a member of “What sets him apart is his ability to the executive committee of the San bring fresh voices into the organiAntonio Mayor’s Fitness Council and zation and encourage their growth chairs their health care committee. and development,” she says. “He The council is developing a toolkit never hesitates to encourage a stufor community physicians to reduce dent, resident, or colleague to get obesity and increase physical activity more involved with TAFP, to run for in the city by providing information a position at the National Conferon free resources that they can share ence of Constituency Leaders, or to with their patients. participate in a committee meeting. Kumar mentors medical student He makes our organization stronger organizations like the UTHSCSA with this aspect of his leadership and FMIG and the TMA medical student service.” section. He mentors students in As chair of the Committee on community service learning projects Public Health Issues within the AAFP – Kaparaboyna Ashok Kumar, MD outside of the curriculum, like FronCommission on Health of the Public tera de Salud, which provides health and Science, Kumar spearheaded the education and screenings to undercreation of a many policies including served patients. Carlos Jaen, MD, PhD, aptly wrote in a nomination a statement on tobacco cessation, and as chair of the AAFP Commisletter that Kumar mentors “learners to become leaders.” sion on Membership and Member Services he made medical student membership free. [cont. on 22]

“My way of leadership is servant leadership. I want my students, residents, and even my own children to see this in my life. This is not lecturing them; I actually want them to witness it.”

TEXAS FAMILY PHYSICIAN [No. 1] 2017

JONATHAN NELSON

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[cont. from 20]

JONATHAN NELSON

TEXAS FAMILY PHYSICIAN [No. 1] 2017

“I want to influence the students not only in the family medicine clerkship and curriculum within the medical school but also in their outside life,” Kumar says. “That way they see family medicine in a much wider perspective, how we can take care of people in our community.” Kumar is a champion of family medicine, demonstrating the broad scope of the specialty to his students through service and patient care. Lloyd Van Winkle, MD, a TAFP and AAFP leader and Kumar’s colleague, wrote in a nomination letter that his “ability to inspire students to follow their hearts into family medicine is well known and admired.” “My way of leadership is servant leadership,” Kumar says. “I want my students, residents and even my own children to see this in my life. This is not lecturing them; I actually want them to witness it.” It is clear that Kumar’s actions demonstrate the best qualities of medicine and service. Paul Linden, MS3, wrote in a nomination letter, “Dr. Kumar is an outstanding educator and physician. He is passionate about helping all of the medical students no matter what path in medicine they want to take. He openly encouraged all of us to chat with him about any issue, such as test-taking strategy or difficulty picking a specialty. As a student you get a great boost of confidence to know that if you put in your part there are great faculty out there like Dr. Kumar who have your back.” Another student, Austin Miller, MS3, agrees. “Dr. Kumar daily takes time during clinic to demonstrate abnormal physical exam findings on patients, teach pathophysiology of disease and explain the reasoning of treatments. He is incredibly vested in the success of his students, provides compassionate care to his patients and is a prime example of the kind of physician that we should strive to become.” His children, Nikhil, 24, and Priya, 27, have embraced his model of service to community by following in his footsteps. Nikhil just completed a master’s in history at King’s College in England and wants to teach, and Priya is a resident at the Brown University Psychiatric Program in Providence, Rhode Island. “My daughter is doing exactly the same things as I do with my patient care,” Kumar says. “Even as a student she got letters from her patients. She has the same kind of thinking as I do when she interacts with them. They just adore her. I feel happy to see that she is carrying on the same legacy that I want to perpetuate with my students.” Looking to the future, Kumar looks forward to many more years of service to physicians and patients. “I want to continue to participate in organized medicine for the benefit of patients and preserving the doctor-patient relationship in the future forever because that is something sacred. We need to fight for it. Nobody should be able to interfere in that relationship.” “I want to continue to be a mentor for my students, residents, and learners for as long as possible. That’s my ambition, to continue to practice medicine and serve my patients. I want to be an educator, an advocate, and a physician taking care of patients for the rest of my life.”

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www.tafp.org

FOUNDATION FOCUS James Morgan, MD

2016 TAFP Foundation donors

Thank you to these 2016 TAFP Foundation donors, whose contributions fund scholarships for Texas medical students, family medicine research grants, and travel scholarships for residents to attend continuing professional development activities.

★ = TAFP Foundation monthly donor

Sherri L. Morgan, MD, MPH ★ Mary Helen Morrow, MD Richard Mueller Thomas Edwin Mueller, MD Jonathan Nelson ★ Mary S. Nguyen, MD Donald R Niño, MD ★ Paul B. Oliver, MD James Andrew Paskow, MD Didier F. Piot, MD ★ Henry David Pope, MD George Reininger ★ John R. Richmond, MD ★ Shelley Poe Roaten, MD Leon Rochen

AbbVie, Inc.

Douglas W. Curran, MD

Joann & Bill Hinchey, MD

Larry & Geraldine Roth

Columbus Community Hospital

Lilette Daumas-Britsch, MD

★ Terrance S. Hines, MD

Kristi Salinas, MD

Giddings Intermediate School

★ Kenneth Gayle Davis, MD

Jose R. Hinojosa, MD

★ Sarah Samreen, MD

Harris County Academy of Family Physicians

★ Chrisette M. Dharmagunaratne, MD

★ Farron Cheryl Hunt, MD

★ M. Sandra Scurria, MD

★ Jorge Duchicela, MD

★ Janet L. Hurley, MD

★ Stephanie Segal, MD

★ Tamarah L. Duperval-Brownlee, MD

Melissa Marie Jacaman, MD

Puja Anil Sehgal, MD

Roberto A. Duran, MD

Bruce K. Jacobson, MD

★ Amer Shakil, MD, MBA

★ Bruce Alan Echols, MD

Stephen G. Johnson, MD

Tayma Slaiman Shaya, MD

Rachel Edwards-Ridder

Gregory Royce Johnson, MD

★ Linda Marie Siy, MD

★ Tricia C. Elliott, MD

★ Brian D. Jones, MD

Hubert L. Smith, Jr, MD

★ Christopher S. Ewin, MD

Audrey Lee Jones, D.O.

Annette Smith

★ Robert Floyd Ezell, MD

★ David Arthur Katerndahl, MD

★ Mary Carmen Spalding, MD

★ Antonio Falcon, MD

★ Christina Kelly, MD

Charlotte T. Starghill, MD

★ Troy Treanor Fiesinger, MD

Art L. Klawitter, MD

★ Charles Herbert Stern, MD

JE Fischer

★ Shelley Kohlleppel, MD

★ Sharon Stern, MD

★ Aimee Lyn Flournoy, MD

Roy and Carol Kothmann

★ Donald E. Stillwagon, MD

★ Lewis Emory Foxhall, MD

Edward Kott, MD and Marylee Mueller Kott, MD

★ Paul & Erica W. Swegler, MD

Melecia Fuentes, MD

★ Kaparaboyna Ashok Kumar, MD, FRCS

Amalia Tinoco, MD

★ Kelly A. Gabler, MD

★ Cyrus Timothy Lambert, MD

Ronald Galfione, MD

Thuy Hanh Thi Trinh, MD, MBA

★ Don A. Lawrence, DO

Oscar Garza, MD

★ Ashok Tripathy, MD

★ Eric Ted Lee, MD

★ Melissa Susan Gerdes, MD

★ Lloyd Van Winkle, MD

Donald Lovering, MD

Howard & Juli Gilson

Evelyn Walford

★ Teddy and Henry J. Boehm, Jr, MD

★ Leah Raye Mabry, MD

★ Lisa Biry Glenn, MD

★ Isaac A. Watemberg, MD

★ Lindsay K. Botsford, MD, MBA

Waleed Mahmoud, DO

★ Roland A. Goertz, MD

Andrew H. Weary, MD

★ Emily D. Briggs, MD, MPH

Ayuk Makia, MD

Sa ★ lly Pyle Weaver, MD

★ Dennis L. Brown, MD

Adrian K. Goss, MD

★ Javier “Jake” Margo, Jr., MD

Judge Marcia Weiner

Jeffrey M. Bullard, MD

★ John Edward Green, MD

Patrick & Kathie Masters

Kathleen Welch

Joseph S. Burch, Jr, MD

★ Thomas David Greer, MD

★ Kathy McCarthy, CAE

★ Jim White

Raul Niduaza Calvo, MD

★ Ajay Kumar Gupta, MD

★ William Mike McCrady, MD

Walter D. Wilkerson, MD

Domingo S. Caparas, MD

★ Natalia Gutierrez, MD

William McEntire

Ceri Williams

Thomas and Phyllis Carney

★ Lesca C. Hadley, MD

★ Susan Clymer McMullen, MD

★ Hugh H. Wilson, MD

★ Chinglin Lillian Chan, MD

★ Suhaib W Haq, MD

Martha Mendiola

Howard and Margaret Wolf

★ C. Mark Chassay, MD

★ Rebecca Eileen Hart, MD

Victor O. Mendiola, MD

★ Khalida Yasmin, MD

★ Samuel T. Coleridge, DO

Bill and Gail Hartin

★ Jessica Miley

★ Robert Allen Youens, MD

★ Seth B. Cowan, MD

Clare Arnot Hawkins, MD, MSC

★ Dale C. Moquist, MD

★ Richard A. Young, MD

John Cullen

★ James Michael Henderson, MD

★ Graciela Moreno, MD

Kenneth & Susan Zapalac

National Bank & Trust O3 Plus, LLC Pathology Associates of San Antonio Pine Cove, Inc. Texas Medical Association Texas Medical Liability Trust Don and Carol Akers Marian C. Allen, MD Adanna Juliet Amechi-Obigwe, MD Charles Peter Anderson, MD Ichabod L. Balkcom, IV, MD ★ Madhumita Banga, MD ★ Tom Banning Charles Oliver Barker, MD ★ Lynda Jayne Barry, MD ★ Justin V. Bartos, MD Joane Goforth Baumer, MD ★ Stephen D. Benold, MD Adrian Billings, MD, PhD

Edwin R. Franks, MD

TEXAS FAMILY PHYSICIAN [No. 1] 2017

★ Sheri J. Talley, MD Elliot J. Trester, MD

PHOTO COURTESY OF FRONTERA DE SALUD

From left: Milena Lobaina; Daniela Vazquez Rodriguez; Alexandria Smith; Thiennga Vo; Edward Strecker; Laura Fitzgerald; Fernando Gonzalez; Craig Thomas; Samuel Vega; Norma A. Pérez, MD, DrPH; William Hertzing; Jesse Wu; Paola Bustillos; Jennifer Espinal; and Erik Sanchez. Seated in front of the alien: Guillermo Foncerrada, MD.

ON THE BORDER OF HEALTH By Perdita Henry

the family medicine revolution manifests in many ways. Whether it is residents teaming up with local docs to hold a Hard Hats for Little Heads event or medical students coming together to hold a vaccination drive in their local communities, everyone is doing their part to ensure that communities have the chance to feel how much their family docs care. Just this past December, Frontera de Salud, a student-run volunteer organization at the University of Texas Medical School at Galveston, completed their first mission trip to the Big Bend area. On December 19, 2016, 14 students and accompanying faculty set out on a three-day mission to bring a helping hand to the rural communities of Alpine, Marfa, Presidio, and Candelaria. The goal was to assist physicians who make special visits to provide services for these communities. TAFP member Adrian Billings, MD, welcomed the group to his hometown practice in Alpine and accompanied them as they provided care to people who rarely have the opportunity to see a doctor. “You can do domestic missionary work, and get paid for it, and do something that’s sustainable and prolonged. There are still isolated communities like Presidio and Candelaria that do need health care.” For three days, Frontera volunteers spread out assisting multiple area clinics from morning until evening so students could assist with primary care clinic operations. Students gained practical experience, interacted with the residents seeking care, and provided educational support for patients diagnosed with chronic conditions.

www.tafp.org

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Krentz HB, Auld MC, Gill MJ. The high cost of medical care for patients who present late (CD4 < 200 cells/μL) with HIV infection. HIV Medicine. 2004;5:93-8.

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FROM UNDERSERVED TO FRONTERA DE SALUD Areas like the Big Bend are precisely why Frontera de Salud—which translates to border of health—was created. Kirk Smith and other medical students at the University of Texas Medical Branch at Galveston founded Frontera in 1998, seeking to help underserved areas of the lower Rio Grande Valley. In the early days, Frontera volunteers provided 600 patients with medical care and over the years grew to include additional chapters at other medical schools across the state, expanding its reach to over 10,000 patients per year. Today this student-led organization, with elected student directors, is overseen by Executive Director and Faculty Advisor Norma Perez, MD, DrPH. As access to care became more readily available to people in the Valley, she set her sights on another area that would benefit from their work. After speaking to Billings about the Big Bend area, Perez recognized it as the perfect location for Frontera’s next project and set about cultivating relationships with doctors and community leaders who were familiar with the communities.

there is no grocery store nearby, they can’t buy fruits and vegetables because they are going to spoil, so you have to buy the necessities like beans, bread things that can last longer.” Chronic health problems abound in these communities, hypertension, diabetes, and acute conditions are rampant and often go untreated for long periods of time. It’s bad enough dealing with these conditions but when you add in the distance one must travel to seek medical attention, things go from bad to worse. Without consistent medical care and education, by the time patients can see visiting physicians, their symptoms have risen to a level not often seen in cities.

PHOTO COURTESY OF FRONTERA DE SALUD

FRONTERA DE SALUD, THE BIG BEND, AND THE FUTURE While Frontera’s initial mission in the Big Bend was a success, there is still a lot of work to be done. The goal is to stage two annual events that will continue assisting clinics and visiting physicians and eventually expand to include other specific community events, such as breast feeding, obesity, healthy living, and diabetes education classes to improve public health. Perez and Billings are also A NEW FRONTIER looking to expand Frontera, Like so many rural parts of hoping to create a chapter at Texas, the town of Candelaria Texas Tech University Health has no hospital, no ER, and no From left: Jennifer Espinales, Jesse Wu, and Guillermo and Science Center School of physician in residence. Twice a Foncerrada, MD, visit with a patient. Medicine at the Permian Basin. month a physician comes to see Perez hopes more university facpatients in the West Texas town, ulty across the state will dedicate perched on the north bank of the themselves to “building courses Rio Grande among the yucca and and letting their students know lechuguilla of the Chihuahuan about these areas so they can go Desert. and help make a change.” While Frontera volunteers Billings hopes Frontera volwere briefed and aware of the unteers will be inspired to come challenges facing Candelaria and back. “One thing I think is really the other towns on their itinersexy in medical school education ary, they were not quite prepared is global medicine. It seems like for what they encountered. Medevery medical student and every ical student Edward Stecker had resident wants to go abroad to previously rotated with Billings do an international rotation. I in his Alpine practice, so he knew have always felt that I am doing what a shock the experience domestic missionary work in my might be for less-seasoned volun— Adrian Billings, MD, PhD own town, my own region, and teers. “We are trained in a medimy own country.” cal center so everyone assumes Imagine what could be if the domestic missionary spirit caught there will be specialists, there’s care whenever you need,” Stecker says. fire in medical students and residents across the nation. Imagine what “It is a great eye-opening experience for people to realize that a section would happen if they took to their cars and instead of driving to the of the population does not have these opportunities.” airport, they stopped just a few hours away. These communities are not just medically underserved; they exist in a medical frontier that lacks many features of modern life we take for granted. The students found that Presidio is a food desert. “They have a bus that takes them every week to El Paso or Odessa,” says JenFor more information on Frontera de Salud, how to get involved, nifer Espinales, a student director of Frontera. “They leave at 2 a.m. and to find out if there is a Frontera chapter near you, visit and then they return at 5 p.m. — just to get food. Of course, since www.fronteradesalud.org.

“You can do domestic missionary work, and get paid for it, and do something that’s sustainable and prolonged. There are still isolated communities like Presidio and Candelaria that do need health care.”

www.tafp.org

TAFPPAC FAQs By Perdita Henry What is TAFPPAC? The Texas Academy of Family Physicians Political Action Committee speaks on behalf of more than 8,000 Texas family physicians, med students, and residents through grassroots involvement, personal relationships with elected officials, and political campaign participation and contributions. TAFPPAC is a non-partisan political action committee that supports candidates who demonstrate concern for issues important to family physicians and our patients. Why is TAFPPAC important? TAFPPAC enables us to increase our spheres of influence, and help elect family-medicine-friendly legislators who will help carry the water for us in Austin. Most legislators have a personal physician, or they know one, TAFPPAC allows

I.L. Balkcom, IV, MD Lee Hagar Bar-Eli, MD Justin V. Bartos, MD Stephen D. Benold, MD Henry J. Boehm, Jr., MD Lindsay Botsford, MD, MBA Emily D. Briggs, MD, MPH Matthew Brimberry, MD Chinglin Lillian Chan, MD C. Mark Chassay, MD Victor Chavez, MD Lilette Daumas-Britsch, MD Kenneth Davis, MD Jorge Duchicela, MD Tamarah Duperval-Brownlee, MD Troy Fiesinger, MD

TEXAS FAMILY PHYSICIAN [No. 1] 2017

us to interact with legislators and make sure that they know how the legislation they consider will impact family physicians and patients alike. Donâ&#x20AC;&#x2122;t my membership dues already support TAFPPAC? No. Membership dues, by law, may not be used by the PAC. PAC participation is strictly voluntary and money raised by the PAC is not used to pay for our lobbying efforts in Austin. It is used to support the campaigns of the candidates we deem to be friends to us and who care about our patientsâ&#x20AC;&#x2122; concerns. What has TAFPPAC accomplished thus far? Tort reform was a major victory for Texans. Success in passing a creative loan repayment program was also a win.

Lewis Foxhall, MD Melecia Fuentes, MD Kelly Gabler, MD Melissa Gerdes, MD Lisa Glenn, MD Roland Goertz, MD T. David Greer, MD Ajay Gupta, MD Natalia Gutierrez, MD Lesca Hadley, MD Clare Hawkins, MD, MSC Anne-Marie Herpin, MD Robert Hogue, MD Farron Hunt, MD Janet Hurley, MD Audrey Jones, DO Christina Kelly, MD

Our negotiations with nurse practitioners resulted in a better outcome for our patients and members. But more importantly, our advocacy efforts have helped prevent a lot of bad legislation. How can I contribute to TAFPPAC? Contributions can be made from a Professional Association, Professional Corporation, or Limited Liability Partnership, but cannot come from any corporate source.

For more information on TAFPPAC and how to donate visit TAFP.org/ TAFPPAC. Contributions are voluntary and are not tax deductible. All contributions will be reported to the Texas Ethics Commission in accordance with state law.

K. Ashok Kumar, MD, FRCS James Lackey, MD C. Tim Lambert, MD Eric Lee, MD Francis Lonergan, MD Leah Raye Mabry, MD Javier Margo, MD Ronnie McMurry, MD Dale Moquist, MD Graciela Moreno, MD Mark Nadeau, MD, MBA Nancy Naghavi, DO Mary Nguyen, MD Paul B. Oliver, MD Amer Shakil, MD, MBA Linda Siy, MD Mary Spalding, MD

Dana Sprute, MD, MPH Erica W. Swegler, MD Sheri Talley, MD James Terry, MD Todd Thames, MD, MHA Ashok Tripathy, MD Thao Minh Truong, MD Lloyd Van Winkle, MD Hsin-Yi Janey Wang, MD Andrew H. Weary, MD David White, MD Keith Wilkerson, MD Walter Wilkerson, MD Khalida Yasmin, MD Robert Youens, MD Richard Young, MD

“It’s a wonderful thing to practice family medicine in the state of Texas, to have the opportunity to get to know our patients and their families and to take care of them. As members of the Texas Academy of Family Physicians, we don’t just care for our patients in the exam room. We take care of them at the State Capitol, too. “I’m a monthly donor for the TAFP Political Action Committee because if we want policies that are good for our patients and our practices, we have to elect politicians who understand our issues. Support TAFPPAC and make your voice heard.” Justin Bartos, MD 2016 TAFPPAC Award recipient

www.TAFPPAC.org

www.tafp.org

PERSPECTIVE

You’re invited! Join your colleagues from every state at AAFP’s National Conference of Constituency Leaders By Christina Kelly, MD

the american academy of family physicians National Conference of Constituency Leaders will be held April 27 29, 2017 with a preconference day on April 26 in Kansas City, Missouri. This is the AAFP’s premier leadership and policy development event for underrepresented constituencies, which includes new physicians (physicians in their first seven years of practice), women, international medical graduates, LGBT, and minority constituencies. At this leadership meeting, we gather every year for a purpose. We gather to: learn about how we can make a difference for our patients and our specialty, inspire each other to advocate, lead the way to action, and challenge our colleagues to join us in our efforts. A variety of issues are discussed at this meeting, such as patient barriers to quality health care that you want the AAFP to address, challenges within a variety of practice settings that you want fixed, or changes that need to occur to continually improve family medicine. This leadership meeting ensures that underrepresented constituencies have a voice within the AAFP. I don’t know of any other organization that has a meeting like this. Each year I attend this conference, it is more exciting to me than the last, and this will be my eleventh time to attend! It has been my breath of fresh air, where I can be reminded through the amazing family physicians attending the meeting why I went into family medicine, and why I do what I do at work every day. This meeting has given me so much over the years in terms of inspiration and leadership development. Each year I attend, I take the leadership skills I learn back to my state chapter meetings and my community. I am now more effective at running meetings. I feel more

confident to raise my voice and speak up for my patients when they can’t do it themselves. I am able to develop a plan to advocate for various issues, execute that plan, and succeed in overcoming obstacles to providing my patients the best care possible. At NCCL, I learn how I can make a difference. For those who haven’t attended before, you are missing out! This meeting is an opportunity to meet colleagues from all over the country who share the same passion you do and to learn how to advocate for change to make things better for our patients and family medicine. At this three-day conference, attendees participate in group discussions to identify issues of importance to them. Resolutions are written and presented at five reference committees. Chapter delegates for each of the member constituencies then debate and vote on the resolutions and new leaders for the conference. Check out more info about the meeting at www.aafp.org/ events/aclf-nccl/nccl.html. For those who have attended, you know the legacy of leadership this conference has built over the past 26 years. You have seen past participants go on to run for offices and hold elected positions at the highest levels of state chapters and at AAFP. Consider returning to inspire a new group of leaders to be heard and advocate for change, just like you did. So come one, come all to NCCL this year. Texas always brings a strong group of members, but with you, we can grow even stronger. CME credit is available for attending any of the breakout sessions on an hour-for-hour basis. I look forward to gathering for a purpose with you at NCCL in Kansas City!

Each year I attend this conference, it is more exciting to me than the last. It has been my breath of fresh air, where I can be reminded through the amazing family physicians attending the meeting why I went into family medicine, and why I do what I do at work every day.

TEXAS FAMILY PHYSICIAN [No. 1] 2017

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