Governor Abbott, HHSC Announce Deadline Extension for Medicaid and CHIP Providers to Apply for Federal COVID-19 Relief Funds

Governor Greg Abbott and the Texas Health and Human Services Commission (HHSC) announced that the federal government has further extended the deadline to apply for the CARES Act Provider Relief Fund.

The deadline has now been extended to August 28, 2020 for Medicaid and CHIP providers as the state responds to the COVID-19 pandemic. In addition, starting August 10, 2020, Medicare providers can apply for additional funding from the $20 billion portion of the $50 billion Phase 1 Medicare General Distribution.

More information is available online at the U.S. Department of Health & Human Services website. 

From Office of the Texas Governor website, accessed August 5, 2020.

COVID-19 testing sites to be added throughout Fort Worth

The City of Fort Worth and Tarrant County are expanding COVID-19 testing for residents throughout the city.

Tests will be available at these locations:

  1. Tuesday, Aug. 11, FWISD Scarborough-Handley Field parking lot 6201 Craig St.
  2. Wednesday, Aug.12, Tarrant County College-Northwest Campus, 4801 Marine Creek Parkway.
  3. Thursday, Aug. 13, Beth Eden Missionary Baptist Church, 3208 Wilbarger St.
  4. Friday, Aug. 14, Christ Church Fort Worth Assembly of God, 5301 Altamesa Blvd.

Tests will be available at these locations for one day only before the test site moves to a new location.

Tests will be available from 8-11 a.m. and 2-5 p.m. daily. Tests at all sites are available by online appointment. Residents who do not have access to a computer may call 817-248-6299 to schedule an appointment.

“Fort Worth will continue to collaborate with partners to ensure COVID-19 testing is readily available and accessible to all residents throughout all of Fort Worth,” said Mayor Betsy Price. “Testing plays a critical role in our continued efforts to prioritize public health, keep Fort Worth’s economy open and get our children back in school.”

In coming weeks, additional sites will be added as suitable locations are identified.

“It is vitally important that we bring more testing to Tarrant County,” said Tarrant County Judge Glen Whitley. “We’re excited to expand our partnership with the City of Fort Worth to add more testing across the county, making it easier for residents to get tested.”

The city’s emergency response volunteers will continue to staff two COVID-19 testing sites, which are currently open:

  1. J.P. Elder Middle School, 709 N.W. 21st St. 8 a.m.-noon.
  2. Dickies Arena’s Chevrolet Parking Garage, 3464 Trail Drive. 2-6:30 p.m.

City staff from Police, Fire and Code Compliance departments, along with certified city volunteers for emergency response, are staffing the sites and guiding patients through the self-administered saliva sample collection process. Tests are offered at no cost to the public; however, insurance information is collected, where possible.

Learn more about COVID-19 testing options in Fort Worth and Tarrant County.

View updated testing numbers.

Tarrant County COVID-19 Activity – 8/7/20

COVID-19 Positive cases: 32,590*

COVID-19 related deaths: 414

Recovered COVID-19 cases: 20,329

Data from Tarrant County Public Heath’s (TCPH) report of COVID-19 activity in Tarrant County, updated Friday, August 7, 2020. Find more COVID-19 information from TCPH here.

* These data are provisional and are subject to change at any time.

Deaths and recovered cases are included in total COVID-19 positive cases.

Provide This Letter to COVID-19 Patients Returning to Onsite Work

Originally published by the Texas Medical Association.

By now you’ve probably treated a lot of COVID-19 patients, many of whom have recovered from the illness.

Although employees are not required by law to present a letter from a physician clearing them to return to work, many employers request one.

If your practice doesn’t already have such a letter, the Texas Medical Association has created one that you can customize for your practice.

The letter, which is available here, outlines guidance from the Centers for Disease Control and Prevention (CDC) on when employees who have exhibited symptoms or who have tested positive should return to work. It also explains a negative swab test is not required by law for employees to return to work.

The letter is one of several COVID-19-related documents TMA has created that you can customize for your practice’s and patients’ individual needs. Those resources as well as up-to-date news, information, and tips can be found on the TMA COVID-19 Resource Center.

Let Doctors Be Doctors

By Susan Bailey, MD

Dr. Susan Bailey, AMA President, presented this speech on June 7, 2020, when she was installed as the 2020-2021 president of the American Medical Association:

The inauguration of a new AMA president is typically a very formal, black-tie affair with great celebration and fanfare. In my case, my family and close friends were all excited and ready to fly to Chicago to celebrate with me. 

I had a beautiful gown and Broadway entertainment and red velvet cake for dessert all picked out.  

My grandson was going to look so adorable in his tux . . .  just like his daddy and his uncle did at his age when I became president of the Tarrant County Medical Society.

I was planning one final bow with my predecessors, Drs. Patrice Harris and Barbara McAneny, capping our historic year with three consecutive women presidents.

But the coronavirus had other plans. And seemingly overnight, our world changed.

So here I stand, in a nearly empty studio, talking to you through a video screen. 

And that’s okay. As physicians we understand better than anyone how a health emergency can disrupt even the most carefully thought out plans. 

No matter the circumstance, I am grateful to address you for the first time as AMA president, and I am so honored to carry the mantle of leadership for this organization I have been proud to serve for 40 years.

On this journey to become AMA president, I’ve been asked who my heroes were growing up. We hear about heroes every day now, it seems. 

But what IS a hero? 

Who were my heroes?

I was never particularly into make-believe superheroes as a kid. It was real people in my life whom I most admired and emulated; the people who inspired me and pushed me to a life beyond anything I could have imagined for myself.  

My heroes were my physicians. 

They were my first heroes . . . and they’re still my heroes. 

I had significant allergies and asthma as a little girl, and my allergists were a guiding light in our family. In fact, the McGovern Allergy Clinic in my hometown practically raised me, instilling in me a passion for medicine and teaching me the basics about working in a medical office—how to take a patient’s history, perform allergy testing . . . and how to give a damn good shot.

I grew up in the shadow of the Texas Medical Center in Houston, and many of my friends’ dads were physicians. At that time, in the 1960s, it was always the dads. Thankfully now, it’s moms too.

Although I rarely saw those physicians, I idolized them. After my father had double cardiac bypass surgery in the early ‘70s, one thing that sped his recovery was taking daily walks by the home of his surgeon, Dr. Jimmy Howell, in the hope that one day the doctor would see him and be proud of him.

One day he did see my dad, and he was indeed proud of him . . .  and that kept daddy walking the rest of his life. Oh, how daddy—and our hero Dr. Howell—would be proud today.

What we’ve witnessed in this pandemic and what we know from history is that heroes are defined by their ability to adapt to a changing world, to follow a righteous cause, to overcome immense challenges, and to be changed by it forever.  

The author Joseph Campbell discusses this in his book, Hero with a Thousand Faces, which describes the mythological hero’s journey in 12 stages, establishing the classic story line in everything from the original Star Wars trilogy and Harry Potter to The Wizard of Oz.  

As Campbell describes it, a hero starts off in the ordinary, familiar world, but gets a call to adventure. Think of a humble farm boy on Tatooine getting the call from Obi Wan Kenobi to help save Princess Leia.

At first, our hero is reluctant, even fearful. But a supernatural force or mentor comes along and brings out the most in them. A threshold is crossed, and the adventure begins. Dorothy skips down the Yellow Brick Road. 

On the way, our hero encounters challenges, finds allies, and makes enemies.  

Eventually, our he or she arrives at the ultimate test. Harry Potter confronts Voldemort face to face. This is a dangerous place . . . a dark place . . .  a place where survival is as important as the ultimate goal. There is a fight to the death.

Somehow, someway, the hero prevails, but the story is far from over. Going back to ordinary life is not easy, and there are many bumps in the road. But in the end, our hero emerges, transformed.

Luke is a Jedi Master. Dorothy returns to Kansas. Harry lives out his life as a benevolent wizard.  

That’s the hero’s journey . . .  and it’s been told a million times in a million different ways.

A hero’s journey is our journey . . .  a physician’s journey.  

You start off as a young student, maybe already in another career, but at some point you hear the call of medical school.

Somebody gives you a hand, maybe a teacher or a co-worker, and miraculously you’ve arrived as a first-year medical student. You feel like an imposter at first, and you wonder if you have made the biggest mistake of your life.

Through wit and resourcefulness, you figure out how to be successful. You don the white coat and you make lifelong friends, all the while confronting clinical challenges that you fear might break you. 

At some point you confront the ultimate test. Maybe it’s having a relationship suffer because your priorities have changed. Maybe it’s not matching into the specialty or program you thought you wanted. Maybe it’s losing your first patient.

You’re in a dark place and it seems there is no way out. But you keep going.

You find your way out of the darkness and you emerge a better physician and a stronger person for having endured these trials. You realize that you are making a difference in people’s lives. You are saving lives.

You’re not the same person you were before you went to medical school. You are a physician . . . and you’re following the hero’s journey.

But here’s the thing – even heroes need allies on their sides. Luke needed R2D2. Harry Potter needed Hermione and Ron. Dorothy needed her ragtag crew.

There isn’t a single person I know who walks this journey alone.

My own allies are far too many to mention and thank in my limited time, but they include my husband Doug, who has been my greatest supporter and partner on this journey. They include my sons Michael and Stephen Wynn and Michael’s partner, Hannah Guel, my precious grandson Jackson, my sister Sally Rudd Ross, and her beautiful family.

They include my wonderful partners, Drs. Robert Rogers and Drew Beaty, my medical assistant Joyce Hayes, and all of their families, and my lifelong friends from Texas A&M University and the Disciples of Christ church.

And it of course includes my family in organized medicine; the Tarrant County Medical Society where I got my start, the Texas Medical Association, and my allergy and pediatric specialty societies the ACAAI, QuadAI, and the AAP. Special thanks to Dr. Melissa Garretson for your friendship, hard work, and dedication to help me make this journey possible.

It also includes my family at the AMA, and all of those colleagues, confidants and executives along the way who have mentored me and become dear friends. I have not named you all by name, but please know you are forever in my heart.

And like any hero’s journey, ours in medicine is simple:

Let doctors be doctors.

After more than 30 years in a small, private practice, I’m a passionate defender of the independent physician, and, like the AMA, I’m determined to remove all those obstacles that have come between us and our patients.

Insurer and government mandates. Decreasing payments and increasing demands. Burnout and physician suicide. And the coronavirus pandemic has made all of these problems more acute. 

We need the power of the AMA on this journey.

I believe involvement in organized medicine is a professional obligation—taking good care of our patients requires much more from us than the time we spend with them in an exam room.

It requires advocacy at the highest levels to fight against the quagmire of regulation and for the support we need to sustain private practice during a pandemic that is threatening its very survival.

It requires us to confront insurance companies and all their familiar tricks that seem to raise insurance premiums year after year without spending a dime more on patient care.  

At times I fear that our nation’s dysfunctional health system is held together only by the oath that we take when we graduate medical school . . .  the pledge to always put the needs and interests of our patients first. 

Whether you took the Hippocratic Oath or, as in my case, recited the Prayer of Maimonides, these words demonstrate our loyalty to public service, to the pursuit of science and knowledge. 

These words bring purpose and meaning to our work, elevating it from a vocation to a profession.

We are on a new quest that none of us expected – living and working in a world that may be changed forever in an angry, divided nation that needs our leadership. But we need not fear the dark times on our journey.

We need only to lean on one another, to take care of each other, and to keep our eyes fixed on the horizon.  

We will get through this pandemic. 

We will continue to fight for our patients and for the practice of medicine. 

This is our journey . . . and we will walk it together.

Thank you.

Closing a Medical Practice

Issues for Physicians to Consider when Closing or Relocating a Medical Practice
by Cheryl Coon, Healthcare Attorney

There are several scenarios that can lead to the closing of a physician’s practice, including relocation, retirement, or an unexpected event such as a serious illness or disability. There are many issues to be considered when closing a practice, including what to do with patient medical records. If the physician is part of a physician group practice, often the employment agreement, shareholder agreement, or other related agreement will address ownership of medical records and other similar issues. Such agreements, however, rarely address the myriad of other factors that should be addressed. Moreover, compliance with those agreements does not guarantee compliance with laws. 

The following is a short overview of some of the issues that a physician should consider ahead of time to address closing or leaving a practice. In the best of worlds, the physician has planned ahead (some suggest a year in advance for retirement) to address most if not all of the issues noted below, and developed a plan that is known and accessible to other practice and/or family members, including the location of relevant documents and contact information. Note for solo practitioners: terminating an entire practice has more issues to consider than the retirement of one physician in a group practice, such as transfer or sale of equipment, and what to do with any associated real property, whether owned or leased. For the most part, this discussion does not focus on a solo practitioner. 

Before addressing the issues, it is important to note that physicians need to keep accurate and thorough records of the steps taken so that compliance can be verified and the process kept organized. Also, when sending notices, it is important that if the method of communication is not specified in an agreement, notices should be sent via certified mail or using some process that provides a similar evidentiary record. 

Medical Records 
If the physician is part of a practice group, often the practice agreements deal with medical record ownership, transfer, and notification of patients. As noted, however, compliance with the agreements does not equate with compliance with law. In Texas, absent an agreement that states the contrary, employers own the records/work product of employees, and in practice settings, group practice agreements almost always incorporate this concept. 

Texas law also requires that practices provide certain information to physicians who are leaving, to permit the physicians to provide the required notice to patients, discussed below. 

A separate issue related to medical records is record retention requirements under various laws. Physicians need to address the times that various state and federal laws require for retention of patient records in the medical record plan. 

Finally, a note to solo practitioners: having a medical record company serve as custodian is very expensive and should be avoided if possible. It is best to have a plan to transfer records ahead of time. 

As an aside, physicians also should have a plan for preservation of business records that may be necessary in the future, such as for tax preparation.

Notice to Patients 
As noted, practices often have agreements that address notification of patients in the event a physician leaves the practice. Regardless of whether practice-related agreements address notification of patients, the Texas Medical Board (TMB) rules address the issue and have some specific requirements. Under the TMB rules, if a physician relocates, retires, terminates employment, or otherwise leaves a practice, the physician must provide reasonable written notice to patients and provide them with an opportunity to obtain copies of their records or arrange for transfer of their records. Notice (1) can be by either posting notice on the practice website or posting in the local newspaper of greatest circulation in the county, and (2) must also include notice in the practice location, and (3) must include written notice to patients seen in the last two years. 

Also, if the physician wants to recommend another physician to patients in the patient notification or otherwise, the information needs to be included in the retirement/relocation checklist.  The recommendation can be provided to patients in the notice letter discussed above.

Providers also need to review third party payor agreements for notice requirements. 

When providing patient notices, it may be prudent to put a copy of the notice provided in the patient chart, if not for all patients at least for those that are deemed high risk.

Notice to Agencies

Texas Medical Board 
A physician should provide written notice to the TMB of retirement or voluntary relinquishment of a license on the form provided by the TMB. The form must be notarized. If relocating, the TMB must be provided with new contact information. The TMB has an online “change of address” feature and will now accept hard copy notices only in limited circumstances.

Federal Drug Enforcement Administration (DEA) 
When relocating, physicians need to provide written notice to the DEA at least six weeks prior to the move and provide the old and new address for the physician. Notice should be sent to the closest DEA office in the state. Written notice also must be provided for retirement in the same manner. 

Any unused controlled substance prescription forms and other prescription forms must be returned, after being marked “VOID,” to the Texas State Board of Pharmacy within 30 days of (1) when the physician’s DEA license/number is canceled, revoked, suspended or surrendered, or (2) the date the physician died. 

If an entire practice is closing, controlled drugs will need to be inventoried and disposed of in accordance with federal and state laws, with particular care given to the disposal of controlled substances. Laws to be considered include the new Environmental Protection Agency laws on disposal of discarded (or waste) pharmaceuticals. Note that non-controlled drugs may be (1) donated, such as to community medical clinics, under the Texas Prescription Drug Donation Program established by the Texas State Department of Health Services, (2) sold with a practice, or (3) disposed of in accordance with laws.
 

Medicare/Medicaid, Tricare,
other HMOs and PPOs 

Upon retirement, physicians must notify Medicare and Medicaid and submit a voluntary withdrawal form. For Medicaid, physicians leaving a group practice must send a letter or a Provider Information Change Form to the Texas Medicaid & Healthcare Partnership. If the physician is joining a new group, the physician also must complete a new Texas Medicaid Provider Enrollment Application. 

Tricare, HMOs, and PPOs, as well as other third-party payors, will almost certainly have similar provisions. Physicians need to review all these agreements for this issue and other issues noted herein, i.e., provisions relating to patient notice and payment on termination.

Notice to Others 

Hospitals 
If a physician has privileges at a hospital, he or she needs to review the hospital bylaws and other policies carefully to see what obligations exist for retirement or relocation, whether related to notice or otherwise.

Liability Insurance Carrier 
Most liability policies now are “claims made” policies, meaning that the insurance company will pay claims made during term of the insurance contract. Therefore, if a physician leaves a practice, the general liability policy will terminate and a “tail” policy to cover claims made after the termination is crucial. In some instances, the practice will cover this expense, but the physician should verify this and obtain a certificate of insurance showing the coverage. If the practice does not provide a tail policy, one should be obtained.

National, State, and
County Medical Societies 

Physicians can provide notice to the American Medical Association by a call to its 800 number, an email or letter, or on-line. The same is true for most medical societies, including the Texas Medical Association and the Texas Osteopathic Association.

National Provider Identification System 
If the physician has a national provider identifier, the physician needs to provide notice to the National Plan and Provider Enumeration System by phone, mail, or email (again, remember that having a written record is vital).

Employees 
Physicians at some point need to notify employees so they can seek other employment at the appropriate time and so they can assist with issues such as patient notification and other transition issues.

Landlord 
Assuming the termination of a solo practice or of an entire group practice, real estate becomes an issue, particularly if the practice location is leased. The physician and his or her attorney should review the lease carefully to determine notice requirements and terms related to termination of the lease.

Supplies/Vendors 
Physicians should review their supplier and vendor agreements to see if there are provisions relating to termination (and/or relocation) and notification, or other issues that may be relevant. If there are standing orders, these will need to be addressed and possibly the issue of returns and/or credits.
Utilities/Other Accounts 

Notices to utilities and other accounts are relevant in the event a solo practitioner or an entire practice terminates or relocates. Aside from utilities, banks are clearly a significant area for review and planning. This should include making sure that access to accounts is controlled, appointing someone to be responsible who can deal with issues, particularly if physician death is the trigger. 

Review should include any subscriptions that the physician may have for magazines and periodicals from memberships in professional societies or other business-related accounts. 

Additionally, if there is an after-hour call service or something similar, the relevant agreement should be reviewed and the termination coordinated with the service.

Post Office 
Notice should be given to the post office for any change of address and/or mail forwarding.

Review all Professional Agreements 
One of the first steps for a physician should be to carefully review all professional related agreements, particularly any employment agreement or shareholder agreement if the physician is a shareholder in a professional association. Items to look for/consider include the following: 

  1. Required notice to the practice of intent to leave or retire 
  1. Non-competition and non-solicitation provisions 
  1. Medical records ownership
    and transfer 
  1. Notice to patients 
  1. Insurance, in particular issues related to tail coverage 
  1. For shareholders, transfer of shares, both the process and valuation. What notice is required? How will shares be valued? What is the timing of the buyout? 
  1. Did the physician sign any guarantees on loans for equipment, operations, real estate, or otherwise?

Winding Down anyProfessional Entity 
Physicians should assess if a professional entity, for example, a professional association or “PA,” needs to be shut down, or as the laws refer to the process, wound down and terminated.  If applicable, winding down and termination of a professional entity is a multi-stepped process that involves filing with two different agencies in Texas: the Texas Secretary of State and the Texas Comptroller. Parties will need to address tax issues and more than likely involve an accountant, preferably one who is already familiar with the practice.   In fact, the entity must file a certificate of account status from the Texas Comptroller indicating that all its taxes have been paid and it is in good standing with the Comptroller as part of the package of documents that must be filed with the Texas Secretary of State (SOS).  A certificate of termination must be filed with the SOS.

Additionally, state law requires that an entity that is winding down have a dissolution plan which addresses how claims and assets will be dealt with and distributed, and that dissolution plan must be approved as required by law. 

If there was an assumed name, that name will need to be released by filing a form with the SOS.

Licenses 
If the provider had any x-ray equipment or other equipment that required a license, the relevant licenses will need to be addressed and notice provided to the appropriate licensing agency, the Texas Department of State Health Services. 

Any wall licenses displayed should be stored in a secure location to help prevent fraud. 

Other 
Physicians should consider the tax consequences and financial issues associated with retirement and/or relocation, such as whether there are any outstanding loans (e.g., equipment, real property, other) and whether any real property has liens associated with it. Final tax returns will be required if the entire practice is closing. 

Conclusion 
In summary, there are a myriad of issues that physicians need to consider in advance of any planned retirement or relocation, and the help of other professionals is highly advised, from tax advisors to accountants and attorneys. Particularly when reviewing agreements, having someone versed in the lingo and contract law will reduce confusion and/or frustration and time. 

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