Robert "Sam" Tessen, Executive Director

"A man's character may be learned from the adjectives which he habitually uses in conversation"      Mark Twain
 
"The only trouble with resisting temptation is that you may not get another chance"

IN THIS ISSUE, FOR YOU:
ON THE SCHEDULE AND DISTRICT MEETINGS
AOA HEALTH POLICY NOTES
TEXAS RANKS 32ND IN SERIOUS PHYSICIAN DISCIPLINARY ACTIONS
MEDICAL PRACTICE ADJUSTS TO PROVIDERS SEEKING WORK-LIFE BALANCE
REVISED ADVANCE BENEFICIARY NOTICE (ABN) OF NONCOVERAGE
QUICK REFERENCE INFORMATION:  MEDICARE PREVENTIVE SERVICES CHART
LOOK OUT FOR HIDDEN FEES
MORE ADULTS HAVE SLEEP ISSUES
ANTICIPATE PATIENT-DRIVEN AMENDMENTS WHEN SELECTING AN EHR 
PATIENTS PREFER TO CHALLENGE NURSES ON SAFETY ISSUES
REGISTER TODAY FOR 113TH AOA CONVENTION AND SCIENTIFIC SEMINAR IN LAS VEGAS
1994 ALL OVER AGAIN?  PUBLIC OPINION AND HEALTH CARE
SURVEY:  AMERICANS SHARE PRESCRIPTION MEDICATIONS
ATOMA MEMBERSHIP:  Add ME to the Texas Osteopathic Family!
COMMON SENSE AND A SENSE OF HUMOR ARE THE SAME THING, MOVING AT DIFFERENT SPEEDS.

ON THE SCHEDULE AND DISTRICT MEETINGS:
  
District 8         Thursday, May 22nd, 6:30 p.m.
                     Utopia World Cuisine
                     Corpus Christi, TX 

District 10       Tuesday, May 27th, 6:30 p.m.
                     Lubbock Country Club
                     Lubbock, TX

District 7         Friday, August 8th
                     Reception and Mixer to welcome incoming residents
                     TOMa bUilding, 1415 Lavaca
                     Austin, TX
 
District 7         Thursday, August 21st

May 17th        Graduation, UNTHSC, Fort Worth, TX   

June 19-22, 2008  Joint Annual Convention - TOMA & TX ACOFP
                         Intercontinental Hotel, Dallas, TX
         

National Volunteer Week:                            April 27-May 3, 2008 (this week)
National Nurses Week                                 May 6 - 12, 2008
National Hospital Week                                May 11 - 17, 2008
Mother's Day                                             May 11, 2008

AOA HEALTH POLICY NOTES

The American Diabetes Association reported that diabetes cost the nation $174 billion in 2007, up from $132 billion in 2002; the disease affects 17.5 million people in the US, and 1 million people are diagnosed with it each year.

A recent analysis by PricewaterhouseCoopers found that over half of the $2.2 trillion the American health care system spends each year is "wasted" paying for medical errors, insufficient use of information technology, and poorly managed chronic diseases, the 4/23/08 USA Today reported. 

The Agency for Healthcare Research and Quality has undertaken a new campaign called "Real Men Wear Gowns" to educate the public and encourage middle-aged men to learn about the preventive and screening tests they need to take.   http://www.ahrq.gov/realmen/

A new study presented on 4/16/08 at the American Academy of Neurology meeting suggested that heavy drinkers and smokers tend to develop Alzheimer's years before people who don't drink or smoke as much. 

Autopsies have shown that people who have larger brains tend to be less vulnerable to the plaques and tangles that characterize Alzheimer's, suggesting that those with larger brains can compensate for some loss without developing the disease. 

TEXAS RANKS 32ND IN SERIOUS PHYSICIAN DISCIPLINARY ACTIONS
Study: Medical boards need to do more to protect patients

AUSTIN- Texas is lagging in the number and rate of serious disciplinary actions taken against doctors, according to a new report. The Lone Star State dropped from 27th to 32nd in the nation, with 136 serious actions taken in 2007, the report from Public Citizen says.

Among all states, disciplinary actions against physicians have decreased for the third consecutive year. Since 2004, the number of serious disciplinary actions - revocations, surrenders, suspensions, and probation/restrictions- against doctors has decreased 17%, resulting in 553 fewer serious actions in 2007 than in 2004. With the increasing number of U.S. physicians since 2004 factored in, the rate of serious actions has dropped 22% in three years, from 3.72 actions per 1,000 physicians to 2.92 in 2007, according to the report, which uses data just released by the Federation of State Medical Boards.

"The lack of doctor discipline in many states equates with a lack of patient protection for those patients whose physicians would have been disciplined in states with better enforcement of their state medical practice acts," says Sidney Wolfe, MD, director of the Health Research Group at Public Citizen.

Jill Wiggins, public information officer at the Texas Medical Board, says the Public Citizen data is not an accurate reflection of the number of serious disciplinary actions taken by the board last year. "Every state has its own set of standards, resources, and medical practice acts, and there is so much variety between the states that it's not fair to compare them. We're also not clear on Public Citizen's methodology," says Wiggins. For example, she says, the report separates out what they call serious actions, whereas the TMB counts each action taken, regardless of severity. In addition, not all of TMB's actions were included in the federal report that Public Citizen gleaned its information from, says Wiggins.  "About 20 percent of our actions did not make it into the report. If they had, our ranking probably would have been where it normally is, right in the middle."

Wiggins says that the additional data would have increased the board's total actions to 370 from 136. "It's kind of ironic that physicians are saying we're too tough at the same time Public Citizen is reporting that state boards aren't doing enough. My attitude is that if you have both sides mad at you, you're probably doing something right," she says.

TMB has been under fire since last year from physicians who say the board is too tough and has become over-aggressive in its investigations. Doctors and some lawmakers also say the board wastes time and resources investigating doctors for minor record-keeping violations.  Wiggins says the board has addressed some of those issues by implementing a new "fast-track" program that essentially treats minor violations like traffictickets. "One of the biggest complaints doctors have had in last six or eight months are the 'dings for the little things'- medical records violations, failure to sign death certificates, that kind of thing. These new rules allow a physician to sign the violation, pay the fine, and not have their name published in the newsletter or press releases," she says.

According to the Public Citizen report, South Carolina was the worst state when it came to disciplining doctors, with 1.18 serious actions taken per 1,000 physicians between 2005 and 2007. The top five states at disciplining doctors are Alaska (8.3 actions per 1,000 physicians) Kentucky (6.55), Ohio (5.71), Arizona (5.37), and Nebraska (5.19). - Kathryn Mackenzie

From:  Texas Healthflash, by HCPro, Inc., www.healthleadersmedia.com

MEDICAL PRACTICE ADJUSTS TO PROVIDERS SEEKING WORK-LIFE BALANCE

Some younger medical providers are favoring a better balance between career and family, leading them to practice models and specialty areas that offer more flexibility and free time. Areas such as internal medicine, pediatrics and family medicine are experiencing added strains, but a move to a team-based approach of doctors, nurse practitioners and physician assistants is helping to meet the needs. The Wall Street Journal (subscription required) (4/29)

From:  SmartBrief, www.SmartBrief.com

REVISED ADVANCE BENEFICIARY NOTICE (ABN) OF NONCOVERAGE

A revised Advance Beneficiary Notice (ABN) of Noncoverage (CMS-R-131) was released on March 3, 2008, and providers are authorized to begin using the notice immediately.  Beginning September 3, 2008, all providers, practitioners, and suppliers paid under Part B, as well as hospice providers and religious non-medical health care institutions (RNHCIs) paid exclusively under Part A, must use the revised ABN in place of the ABN-G (CMS-R-131-G) and ABN-L (CMS-R-131-L).  Revised manual instructions in Chapter 30 of the Claims Processing Manual (Pub. 100-04) will be published within the next few weeks and a Medicare Learning Network (MLN) Matters article will also be released at that time.  The revised ABN and form instructions can be accessed at http://www.cms.hhs.gov/bni

QUICK REFERENCE INFORMATION:  MEDICARE PREVENTIVE SERVICES CHART
 
This  two-sided laminated reference chart gives Medicare fee-for-service physicians, providers, suppliers, and other health care professionals a quick reference to Medicare's preventive services and screenings. (Feb. 2008)

http://www.cms.hhs.gov/MLNProducts/downloads/MPS_QuickReferenceChart_1.pdf

LOOK OUT FOR HIDDEN FEES

In today's economy, there is increasing pressure to offer patients every possible method of making payment. So, after you decide to sign up with a credit card processing company and start accepting Visa and MasterCard, you have nothing else to worry about, right?

Not so fast. If you think like this, you may be losing a lot of money.  "With many companies there are a lot of hidden charges doctors don't see on the surface," says Paul Soparnarat of Heartland Payment Systems. Many processing companies take advantage of the complexities of interchange rates, markups, other related fees, and complicated fee structures to keep physicians from knowing exactly how much each transaction costs them.

Take a look at some of the more common tricks credit card processors use:

Fee increases -- Visa and MasterCard adjust rate categories one to two times each year. When rates go up, some companies and their agents use the opportunity to inflate them even more -- and then deceptively blame the increase on Visa/MasterCard.

Fee reductions -- Annual fee adjustments by Visa/MasterCard may also include reductions in some card transaction categories as well as incentives for certain categories of merchants and card types. Yet, merchant acquirers and their middlemen rarely pass these reductions on to small- and medium-sized merchants.

Middlemen -- Card processing is a fairly simple process that requires four entities at most: a bank, a Visa/MasterCard, a telephone or Internet connection, and a processor. In some cases, however, as many as 12 additional, but different, entities get involved; each one taking a cut.

Surcharges and bill-backs -- Visa/MasterCard charges as many as 110 different interchange rates. These are set by Visa or MasterCard and cannot be changed by a merchant acquirer. However, many merchant acquirers or their middlemen significantly inflate these set fees with surcharges -- often called "bill-backs" or "enhancements" -- that frequently are deducted the month following the actual transaction without disclosure.

Reasonable equipment costs -- Availability of card processing equipment has become widespread, with warehouse clubs, consumer electronics stores, and online auctions routinely providing this equipment at very reasonable costs. Yet, many merchant acquirers sell the concept of multi-year leasing, locking physicians into costly, non-cancellable, long-term commitments.

Take the time to look carefully for these signs in your statements. If you have a question, ask your customer service representative. If you do not get a satisfactory answer, start thinking about doing business with another company.

What else to look for in a processing merchant:

Encrypted card numbers and secure transactions
Real-time fraud and transaction monitoring
Live customer support 24/7

Card processing services can be a high expense many small- and medium-sized practices unknowingly incur, hidden on their P&L statement as "bank fees." Often these costs are unnecessarily high; careful attention to the details of your credit card processing can really pay off.

Despite the complex nature of credit card economics and the potential for bottom-line erosion, it still may be worth it to accept them. Offering patients the option of making payment via credit card could be better for your practice than sending endless bills that may or may not get paid.

Karen Zupko is a seasoned senior advisor who has been helping physicians navigate America's healthcare system since 1974. Her perspective stems from more than 25 years of consulting, coaching, and training experience with physicians and those who manage them. She is a member of the American Marketing Association and Women in Communications, and she has served on the board of trustees of Chicago's Grant Hospital. Karen is a graduate of the University of Kansas and a Chicago native. You can contact her at kzupko@karenzupko.com. 

From:  Physicians Practice Pearls, from Physicians Practice,  www.PhysiciansPractice.com.

MORE ADULTS HAVE SLEEP ISSUES

Research shows insomnia affects almost half of adults aged 60 and older, which can increase their risk of obesity, cardiovascular disease and diabetes. Experts say sleeping patterns may change with age, but disturbed sleep is not normal. Medications and illness can affect sleep for older adults, along with obstructive sleep apnea and restless legs syndrome. Yahoo!/HealthDay News (4/27)

http://news.yahoo.com/s/hsn/20080428/hl_hsn/elderlymorelikelytobattlesleepdisorders;_ylt=AkGKhG0spnbUIfkgrJZffbPVJRIF

ANTICIPATE PATIENT-DRIVEN AMENDMENTS WHEN SELECTING AN EHR 

The HIPAA privacy rule permits patients to amend their medical records-and recognition of this right is on the rise as more hospitals transition from paper to EHRs.  With this increase in mind, be sure to ask these questions when selecting an EHR vendor:

Does the vendor's system allow amendments, or will it be necessary to amend records on paper and then scan them into the record?

Does the vendor's system allow you to easily view corrections? This information helps physicians understand why other practitioners may have made certain clinical decisions based on information available at the time.

Does the vendor provide an audit trail? If so, be sure to activate it.

This tip comes from the April issue of Medical Records Briefing.
From:  EHR Connection, HCPro, Inc., www.hcmarketplace.com

PATIENTS PREFER TO CHALLENGE NURSES ON SAFETY ISSUES

Patients feel more comfortable questioning nurses than doctors when it comes to matters of safety and their healthcare, says a study in the journal Quality and Safety in Health Care. The study also reports that women are far more likely to speak up than men.
http://www.healthleadersmedia.com/content/210294/topic/WS_HLM2_QUA/Patients-prefer-to-challenge-nurses-rather-than-doctors-on-safety-issues.html

From:  HealthLeaders Media QualityLeaders, www.healthleadersmedia.com

REGISTER TODAY FOR 113TH AOA CONVENTION AND SCIENTIFIC SEMINAR IN LAS VEGAS

The 113th AOA Convention and Scientific Seminar, taking place October 26-30, provides you with a great opportunity to earn up to 40 CME hours.  In fact, you can earn enough Category 1-A CME hours to fulfill your AOA membership requirement for an entire three-year cycle. Read More:  http://newsmanager.commpartners.com/aoatouch/issues/2008-05-01/1.html

1994 ALL OVER AGAIN?  PUBLIC OPINION AND HEALTH CARE
Perspective
L.R. Jacobs

Free Full Text:  http://content.nejm.org/cgi/content/full/358/18/1881?query=TOC
From:  The New England Journal of Medicine, www.nejm.org

SURVEY:  AMERICANS SHARE PRESCRIPTION MEDICATIONS

Almost 25% of Americans share their prescription medicines, a survey found. Allergy drugs, pain medications and antibiotics were among the most frequently shared drugs cited in the survey. HealthDay News (4/29) , Reuters (4/29)  http://healthday.com/Article.asp?AID=614989

From:  SmartBrief, SmartBrief, Inc., www.SmartBrief.com

ATOMA MEMBERSHIP:  Add ME to the Texas Osteopathic Family!
 
For Osteopathic Physicians, Family and Friends - $30 due now for 2008!
(The ATOMA directory is being prepared NOW, so don't delay, please.)
 
NAME:______________________________________________
 
Mailing Address:______________________________________
 
EMAIL: _____________________________________________
 
Telephone:__________________________________________
 
Mail $30 check today to ATOMA, c/o Texas Osteopathic Medical Association, 1415 Lavaca, Austin, TX 78701.  OR Fax credit card info to TOMA @ 512-708-1415.
 
Any questions?  Wondering if you've paid already - or forgot?  Please email Deidre Froelich, ATOMA Membership,  d2froelich@verizon.net with any questions.  Fax 903-583-1234. 

We want YOU in the TxDO Family!  If you don't think you have TIME to be an ATOMA member, please be aware that ATOMA welcomes you on YOUR terms.  We welcome financial supporting members as well as active participants.  This is YOUR family; be comfortable.  One size ($30) fits all.  Join today!  (Thank you! DLF)

COMMON SENSE AND A SENSE OF HUMOR ARE THE SAME THING, MOVING AT DIFFERENT SPEEDS.

As he was approaching the teller's window at his bank, a man tripped and careened forward. Fortunately, he caught himself before he fell.  "Apparently, sir," the teller said, "you came here to get your balance."

A married couple was celebrating their 60th wedding anniversary. At the party everybody wanted to know how they managed to stay married so long in this day and age.  The husband responded "When we were first married we came to an agreement. I would make all the major decisions and my wife would make all the minor decisions. And in 60 years of marriage we have never needed to make a major decision."

One nice thing about egotists: they don't talk about other people.

I'd like mornings better if they started later.

I believe the only time the world beats a path to my door is when I'm in the bathroom.

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ADVOCATE DO MEDICAL LIABILITY COVERAGE FOR DO's

As a TOMA member, you are eligible for the TOMA Preferred Program which offers discounted rates on medical malpractice insurance premiums from Advocate, DO.  TOMA has partnered with Advocate, DO to bring you competitive rates, free risk management assessments, in-house legal assistance, aggressive claims management and a claims-made policy that does not expire.  In addition, you will receive Texas Medical Board coverage with separate limits, no deductible and no out of pocket expenses!  Advocate, DO does not require any surplus charges, TMA or County Medical Association dues and will provide prior acts coverage.

Take full advantage of your TOMA Preferred Program discounts, call Advocate, DO today - (800) 686-2734 or visit www.advocatedo.com.

Advocate, D.O.

Underwritten by Advocate, MD Insurance Company of the Southwest Inc.

800-686-2734 or 512.275.1830

www.advocatedo.com