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TMA Report

The development of TMA policy

by Gary Floyd, MD, TMA President

This article was originally published in the September/October 2022 issue of the Tarrant County Physician. You can read find the full magazine here.

Over the past year, the Texas Medical Association has had to weigh in on one sensitive topic after another—from issues impacting the patient-physician relationship to how physicians practice medicine and the prevention of further cuts in the Medicare program.

Often, after TMA publishes its stance in the association’s daily newsletter, Texas Medicine Today, we receive inquiries from members on how TMA came up with that position since no one surveyed them individually or asked for their opinion. This has made me realize many of our members don’t understand who runs TMA or the process TMA uses to develop its policy, which drives the association’s communications and advocacy. 

The association is governed by a 500-member House of Delegates, the legislative and policymaking body. The House is made up of elected county medical society delegates (one delegate per 100 members or fraction thereof) and the following ex officio members: members of the Board of Trustees; 15 councilors; Texas delegates and alternate delegates to the American Medical Association; members of the Council on Legislation and chairs of the other councils; delegates from the Young Physician Section, International Medical Graduate Section, Resident and Fellow Section, Women Physician Section, LGBTQ Section, and Medical Student Section; and delegates of selected specialty societies.

The House of Delegates meets every year at an annual session held during TexMed in the spring. In 2023, TexMed will be in Fort Worth on May 19–20.

The best way to get your idea adopted as TMA policy is to begin at the grassroots level. 

1 Present your idea or change to an existing policy at your county medical society meeting. Ideas and actions also are developed by association boards, councils, committees, and sections. You can work with these groups to develop a policy recommendation.

2 If the county society, section, or other entity agrees, it can submit your idea as a report or resolution to be considered at the next meeting of the House of Delegates. Instructions for writing a resolution are at http://www.texmed.org/Resolution.

3 Every report and resolution is assigned to a reference committee that vets it further through open hearings at which any TMA member can testify. The reference committees then send their recommendations on each report and resolution to the house. If you would like to serve on a reference committee, let our House of Delegates speakers know by filling out the form at tma.tips/refcom. 

4 If your idea is adopted by the house, it is incorporated into the TMA Policy Compendium (www.texmed.org/Policy). If it has nationwide appeal, it may also be forwarded to AMA for action.

As TMA president, I am obliged to represent our TMA policies. As you can imagine, we have members on both sides of several very sensitive issues. Some members would like TMA to issue an immediate, strong opinion favoring their stance. However, by working with our legislators, we have learned that calm, measured, commonsense approaches are far better received than knee-jerk responses. Therefore, in our responses we tend to emphasize areas of commonality for our members, like protecting the sanctity and privacy of our patient-physician relationships and creating a safe environment for our physicians to exercise their best medical judgment in providing the appropriate standard of care for all their patients. 

Please reach out to your county medical society and learn more about TMA’s policymaking process. We want to hear from you!

Physicians Urge Texans to Safely Return Unused Prescription Medication

Saturday is National Prescription Drug Take Back Day

Have unused, unneeded prescription drugs at home? Turn them in now, physicians say.

Texas doctors recommend people with unused or expired prescription drugs at home dispose of them safely this weekend, so they are not accidently consumed.

As the state grapples with a sharp increase in opioid overdose deaths, the U.S. Drug Enforcement Administration is organizing its biannual prescription drug Take Back Day on Saturday, Oct. 29. Prescription drugs can be returned anonymously at pop up locations across the state. Syringes or illegal drugs cannot be taken.

Returning unused medication is an important step to prevent misuse of prescription medication, especially opioids.

“The overwhelming majority of people who suffer from opioid addiction got started by getting opioids from friends and family,” said C.M. Schade, MD, a Texas Medical Association (TMA) physician leader and past president of the Texas Pain Society (TPS). “Their opioid addiction was not caused by taking opioids that were prescribed to them.”

According to the 2020 National Survey on Drug Use and Health, more than 9 million people aged 12 and above misused prescription pain relievers like hydrocodone, oxycodone, morphine, and prescription fentanyl.

Dr. Schade warns that consuming medication not meant for you can be life threatening. “Taking opioids that are not prescribed to you is especially dangerous because in the opioid-naïve patient it causes breathing problems that can cause brain damage and even death.”

Dr. Schade also said giving your prescription medication to others is both illegal and harmful. “You will be intentionally or unintentionally enabling dysfunctional behavior, which is not only unhealthy but oftentimes leads to addiction and/or death.”

While Dr. Schade noted illegal drugs – especially those laced with fentanyl – are largely to blame for the opioid epidemic, safely disposing of prescription medication is one way to prevent an overdose from occurring.

“The drug take-back program, while important, only removes one source of drugs that people who are addicted can use to get a drug to satisfy their addiction,” he said. “What is needed is a comprehensive program to engage these people in the health care system so that they will get medical care such as counseling and medication-assisted treatment.”

TMA and TPS physicians have been raising awareness about the dangers of street drugs. Dr. Schade testified before the Texas House Committee on Public Health last month and offered lawmakers several recommendations to curb deaths from illegal opioids including making naloxone – a medicine that reverses overdose – available over the counter without a prescription.

Join TMA’s 2022 Fall Conference This Weekend

TMA’s annual Fall Conference will be held this weekend in Austin, TX! Register now to join the event, where you will have the opportunity to network with other physician, conduct TMA business, and go to CMEs and lectures centered around top healthcare issues and interests.

Here are the details:

When: September 16-17, 2022

Hotel: Hyatt Regency Lost Pines Resort and Spa

Parking Information: Daily self-parking is $12.00 for attendees and hotel guests. Guests not staying overnight can pick up a voucher at the TMA registration desk. Overnight valet parking is $38 plus tax, no in/out privileges.

Agenda

FRIDAY, SEPTEMBER 16

  • 7:30am – 7:30pm Registration Hours
  • 1:00 – 5:00pm Exhibits, Lost Pines Ballroom Foyer
  • Many boards, councils, and committees hold business meetings in conjunction with Fall Conference.

SATURDAY, SEPTEMBER 17

  • 6:30 – 12:30am Registration Hours
  • 7:00-noon Exhibit Hours
  • 7:30-8:30am Dawn Duster, Lost Pines Ballroom 57:30-8:30 am Networking Breakfast and Exhibits, Lost Pines Ballroom Foyer9-11:45 am General Session, Lost Pines Ballroom 5
    9-9:30 am Welcome and TMA Update
  • 9:30-10:30 am Take Charge of Your Career: Harness the Power of Negotiation (CME)
  • 10:30-10:45 am Break and Exhibits
  • 10:45-11:45 am Legislative Panel (CME) Hear from our physician legislators with a recap of the 87th Legislative Session and what to expect from the special session next month.

You can view the full schedule here.

Sign Up for TMA’s 2022 Fall Conference

TMA’s annual Fall Conference will be here before we know it! Register now to join the event, where you will have the opportunity to network with other physician, conduct TMA business, and go to CMEs and lectures centered around top healthcare issues and interests.

Here are the details:

When: September 16-17, 2022

Hotel: Hyatt Regency Lost Pines Resort and Spa
Rates start at $229 plus $10 resort fee. Room cut-off date is August 17, 2022. 

Parking Information: Daily self-parking is $12.00 for attendees and hotel guests. Guests not staying overnight can pick up a voucher at the TMA registration desk. Overnight valet parking is $38 plus tax, no in/out privileges.

Agenda

Friday, September 16

  • 7:30am – 7:30pm Registration Hours
  • 1:00 – 5:00pm Exhibits, Lost Pines Ballroom Foyer
  • Many boards, councils, and committees hold business meetings in conjunction with Fall Conference.

Saturday, September 17

  • 6:30 – 12:30am Registration Hours
  • 7:00-noon Exhibit Hours
  • 7:30-8:30am Dawn Duster, Lost Pines Ballroom 57:30-8:30 am Networking Breakfast and Exhibits, Lost Pines Ballroom Foyer9-11:45 am General Session, Lost Pines Ballroom 5
    9-9:30 am Welcome and TMA Update
  • 9:30-10:30 am Take Charge of Your Career: Harness the Power of Negotiation (CME)
  • 10:30-10:45 am Break and Exhibits
  • 10:45-11:45 am Legislative Panel (CME) Hear from our physician legislators with a recap of the 87th Legislative Session and what to expect from the special session next month.

You can view the full schedule here.

TMA Statement in Response to U.S. Supreme Court Ruling on Roe vs. Wade

As the Texas Medical Association digests and analyzes the full impact for Texas of the U.S. Supreme Court decision in Roe vs. Wade, President Gary W. Floyd, MD, issued the following statement today in response to the ruling.

“TMA remains committed to protecting the privacy and sanctity of the patient-physician relationship. TMA is unwavering in its stance against intrusions by government or other third parties that impede the patient-physician relationship, and any criminalization of acceptable and appropriate medical practices that may jeopardize that relationship or patients’ safety.

“Especially in high-risk situations, patients need to know their physicians will be there to care for them, and TMA will continue to work with state lawmakers to ensure a safe practice environment for physicians and their patients.”

Check out D CEO Healthcare’s interview with TMA President Dr. Gary Floyd

As part of their “Conversation With” series, which highlights leaders in the North Texas community, D CEO Healthcare sat down with TMA President Dr. Gary Floyd to discuss a range of topics – from restoring trust in medicine to transgender care and legislative priorities. Here’s an excerpt:

“When the public health emergency is declared over, over a million people will lose coverage in Texas. We’ve been trying to work with our legislators about targeted plans to extend coverage. We would like to continue to cover children from birth through six months and expand it to have 12 months of eligibility; We would like to cover pregnant moms postpartum for 12 months. We are trying to improve payment for delivering Medicaid services that haven’t been changed in over 20 years.”

You can read the full interview here.

Burnout is a National Problem – TMA Wellness Fund Can Help

In a recent advisory calling attention to health care worker burnout, U.S. Surgeon General Vivek Murthy, MD, highlighted the broad response the situation calls for: “We must ensure that every health worker has access to affordable, confidential, and convenient mental health care.”

If finances are keeping you or someone you know from seeking treatment for depression, anxiety, substance use, or other conditions, the Texas Medical Association’s PBF Wellness Fund is here to help overcome that barrier.

Through the fund, physicians with a valid Texas medical license can receive financial support for treatment of conditions that impair their ability to practice medicine safely. In addition, qualifying physicians can receive financial support to cover their family’s living expenses while undergoing treatment.  

In the surgeon general’s report, Addressing Health Worker Burnout, Dr. Murthy proposed a variety of approaches to aid the 35% to 54% of physicians and nurses, and 45% to 60% of medical students and residents, reporting symptoms of burnout. He called for individuals, health care organizations, academic institutions, government, and more to help address the problem.

Related to mental health, the advisory calls for such actions as:

  • Eliminating punitive policies for seeking care for mental health and substance-use disorder;
  • Normalizing conversations about mental health challenges, including suicide, in health care learning environments to foster a culture of support and awareness; and
  • Ensuring access to mental health services for health care workers and their families, including the use of telemedicine.

Contact TMA if you or someone you know could benefit from the PBF Wellness Fund. Email Chris Johnson, PBF director, or call her at (512) 370-1602 with questions. Or complete an application. TMA strives to protect the anonymity of fund recipients.

Contributions from physicians and their spouses support the fund. If you want to help, you can contribute via secure, online donation, or send a check to PBF Wellness Fund, Attn: TMA Finance Department, 401 W. 15th St., Austin, TX 78701-1680.

The PBF is a 501(c)(3) organization, so charitable contributions are tax-deductible to the full extent permitted by federal law.

The Uvalde Crisis: Working Together for Real, Actionable Solutions

Statement from Texas Medical Association President Gary W. Floyd, MD

The Uvalde, Texas, school shooting was shocking, and hit me at my very core as a pediatrician, father, and grandfather. I can’t put into words the emotions I felt at the time. But I can tell you the first action I took was to call my Texas Medical Association Board of Trustees colleagues and Michael Darrouzet, executive vice president of TMA, to say, “We have to do something for the Uvalde community. We need to take action to prevent these violent acts from ever happening in Texas again.” Ray Callas, MD, chair of the TMA Board of Trustees, did the same. Together we called for action. 

I know you can relate to our reaction, because as physicians, we fix problems – we are trained to diagnose, treat, and heal. And that is exactly the approach TMA took in its response to the Uvalde crisis. 

TMA went to work immediately to create the Mental Health Rapid Response Team, a coalition of 20 organizations ranging from state medical specialty societies, statewide leaders from community health centers, and social work and psychology organizations to state government resource leaders, such as the Texas Health and Human Services Commission (HHSC), Texas Child Mental Health Care Consortium (TCMHCC), Texas Division of Emergency Management, and Texas Department of Public Safety, to name a few. See the entire list of participants below. The coalition is co-chaired by Dr. Callas and me. 

TMA already had its first meeting with the Mental Health Rapid Response Team to learn what resources are being deployed in Uvalde, what is needed, and how we can collectively help with the response without overwhelming the community or interfering with ongoing efforts by the state. We also started establishing short- and long-term goals for the coalition, focusing on the needs of the Uvalde community, first responders, communities all over Texas that also are dealing with this tragedy, and new legislation we can put before our legislators in January 2023. Being proactive is TMA’s primary goal, in the hope our efforts will prevent such situations from occurring again. 

What we know: Uvalde currently is overwhelmed with offers to help with counseling. TMA’s goal will be to look longer-term, finding in-person counseling for Uvalde during the next year or two. HHSC has asked TMA to create a list of people who are willing to provide long-term counseling services in Uvalde. Eventually, we will need telemedicine services as well. TMA will soon publish information about how to get involved. Please keep an eye out for this. 

TMA learned one valuable lesson from the COVID-19 pandemic: When we work together and learn from each other, we can be much more effective. We are taking that same approach now. This is not a problem we can fix quickly but one that will take time to properly diagnose, treat, and heal. 

Please join TMA as we help the Uvalde community and our state to detect, prevent, and start fixing the many problems affecting our children and families in Texas. 

Sincerely, 

Gary W. Floyd, MD
President
Texas Medical Association

Mental Health Rapid Response Team

Association Participants

  • Child Psychiatry Access Network (CPAN is part of TCMHCC) – Laurel Williams, DO, CPAN medical director; Nhung “Noon” Tran, MD, Texas Pediatric Society liaison to CPAN and CPAN pediatric consultant; and Luanne Southern, TCMHCC executive director
  • Federation of Texas Psychiatry – Phillip Balfanz, MD; Eric Woomer, lobbyist and government affairs consultant; and Courtney Williamson
  • National Alliance for Mental Illness Texas – Greg Hansch, executive director 
  • National Association of Social Workers Texas – Will Francis, executive director
  • Texas Academy of Family Physicians – Tom Banning, CEO/executive director 
  • Texas Association of Community Health Centers – Jana Eubank, executive director
  • Texas Chapter of the American College of Physicians – Nicole Abbott, executive director
  • Texas Counseling Association – Jan Friese, executive director
  • Texas Hospital Association – John Hawkins, president/CEO; Steve Wohleb, general counsel; and Sara Gonzales, vice president, advocacy and public policy
  • Texas Medical Association – Gary Floyd, MD, president, and Ray Callas, MD, chair, board of trustees
  • Texas Nurses Association – Julia Menegay, interim CEO, and Dawn Webb, director of nursing practice and professional development
  • Texas Pediatric Society – Stacey Mather, executive director, and Clayton Travis, director of advocacy and health policy
  • Texas Psychological Association – Angie Guy, interim executive director

State Participants  

  • Office of the Governor – Heather Fleming, advisor
  •  Texas Child Mental Health Care Consortium – David Lakey, MD, chair
  • Texas Department of Public Safety – Steven McCraw, executive director/colonel, and Lt. Charles Havard
  • Texas Department of State Health Services – John Hellerstedt, MD, executive commissioner, and David Gruber, associate commissioner, regional and local health operations
  • Texas Division of Emergency Management – Nim Kidd, Chief
  • Texas Health and Human Services Commission – Cecile Young, executive commissioner, and Sonja Gaines, deputy executive commissioner for intellectual and developmental disability and behavioral health services

This statement was originally published by the Texas Medical Association on June 2, 2022.

Data Transfer Problems Burdensome for Practices, TMA Tells Feds

By Joey Berlin

Originally published by the Texas Medical Association on May 11, 2022.

The federal government is trying to standardize data sharing so electronic health records (EHRs) across the country can all speak the same language. The Texas Medical Association is telling the government to keep working on it.

TMA submitted comments on the draft of version 3 of the United States Core Data for Interoperability (USCDI), which aims to establish data-sharing standards “for nationwide, interoperable health information exchange.” USCDI updates come from the Office of the National Coordinator for Health Information Technology (ONC), which released the version 3 draft in January. The first version of USCDI became part of certain EHR certification criteria.

In an April 27 letter to ONC, TMA offered several suggestions on how to improve the proposed new version, including:

  • Assign “applicable vocabulary standards” to any data elements added to the USCDI so there’s an established way to refer to those data across EHRs. “Adding nonstandard elements will result in an enormous amount of vendor and end-user work that will simply create nonstandard data that are difficult to transfer. It also will create an excessive amount of rework in the future once applicable vocabulary standards are set for these data elements,” TMA said in the letter.
  • Test EHR vendors and users to ensure a smooth transfer of data from previous USCDI versions 1 and 2. TMA told ONC it is hearing from physicians already frustrated “because of the manual manipulation of data received [from EHRs] that places additional burden on practice staff who are already stretched thin.” Information that a physician receives from a hospital, TMA said, “is not always in a human-readable format or is so limited as to be not useful or actionable.”

In fact, then-TMA President E. Linda Villarreal, MD, and Ogechika Alozie, MD, chair of TMA’s Committee on Health Information Technology, urged ONC to delay finalizing and requiring the new USCDI version “until EHR vendors prove their users are able to functionally use USCDI versions 1 and 2 and that all data elements” are streamlined.

Q&A with TMA President Dr. Gary Floyd

By Allison Howard

This article was originally published in the May/June 2022 issue of the Tarrant County Physician.

Photo credit: Texas Medical Association

On April 30, 2022, longtime TCMS member and past president Dr. Gary Floyd was installed as TMA’s 2022/2023 president. A pediatrician who has practiced in Tarrant County for over 40 years, Dr. Floyd sat down with the Tarrant County Physician to talk about everything the led him to this point, and what he anticipates for this next year as he takes the helm of one of the largest medical associations in the country. 

Q  So Dr. Floyd, what would you say, in your opinion, is the best thing about being a doctor?

A  You know, I think the best part or the most amazing part to me is that people, and in my case families, trust you enough to take care of their children. And for adult docs, those patients trust them enough to take care of them. I have always just stood in awe of that. The second part for me has been the collegiality, and that has come both in the workplace and through organized medicine. I have over the years made many acquaintances, many friends, and that’s just not replaceable.

Q  Speaking of the physicians you’ve worked with, how do you think organized medicine – TMA specifically or any of the multiple organizations you’ve worked with over the years – impacts both physicians and patients?

A  I think organized medicine gives us a collective voice for the issues that plague all of us. We can usually come to common consensus, and it gives us a large body of people, a large number of physicians, who will speak out for our issues. And instead of just one person crying in the wilderness alone, you go representing fifty-six thousand members of TMA. People start listening in.

Q  That makes a lot of sense. So, on advocacy: what do you think are some of the most important ways that advocacy has impacted the practice of medicine? I know there’s a pretty long laundry list.

A  There’s a long list, yes. I think for Texas physicians one of our biggest achievements or wins was our liability reform that occurred back in 2003, almost 20 years ago. Thanks to work with the public and literally grassroots in the office in talking to patients, this went before the public in a proposition for a constitutional amendment and passed. So hats off, not only to the physicians who worked so hard on that but to the public who understood the need to bring in more physicians to Texas.

I think you’d also have to hallmark [that TMA] sued CMS and won in the district court in Tyler and now we’re waiting for their appeal. This had to do with the No Surprise Billing act. Congress got it right in their wording and had a very fair independent dispute resolution process. But in writing, CMS’s rules initially came out very much in favor of insurance companies and detrimental to physicians. So that’s why Texas sued and won. It’ll be interesting to see how this will pan out, and whether the federal government will appeal to a higher court. But we’re ready for that battle. It’s an expensive battle, but it’s well worth fighting for physicians and for patients. 

Q  You’ve talked about some issues that are clearly important to you. Focusing on your leadership roles: a lot of physicians are involved in organized medicine but only so many choose to actually get involved on the leadership level, which allows you to really participate in creating change. What inspired you to do so?  

A  I think every leadership position I’ve ever run for or been elected to, it’s been because others have asked me to do it, so I think it’s been because of the relationships that have been built with colleagues as we went through our normal course of work. Showing up to those meetings and participating in committees. And with respect to TMA, not only committees but councils; apparently people agreed with some of the things that were important to me and with the way that I could express that, and those were the folks that asked me to serve in various positions with TMA. And my wife says it’s because I can’t put my hand down and haven’t learned how to say “no!”

Q  Looking back at some of your leadership roles between TCMS, TMA, AMA, and the different organizations you’ve been with, what have been some of the highlights along the way? 

A  I’ve had the incredible privilege to serve as president of Tarrant County Medical Society, now president-elect for the TMA. I’ve been very honored to serve as president for Texas Pediatric Society and president of the Texas chapter of the American Academy of Pediatrics. One of my most fun jobs was when I got to chair the TMA Council on Legislation. That was really a fun time – there was a lot of interaction at the capital, and I’m looking forward to that as president next year since it’ll be a legislative year starting in January. 

But perhaps one of the most challenging positions was serving as chair of our TMA Board of Trustees during the pandemic when we had to become an emergency disaster board. Thanks to the great teamwork by all members of our Board, we got through it and managed to take care of the TMA business that needed handling.

Q  Going back to the legislative session, what are some of your overarching goals for that? And what are some of the things you hope to accomplish during your presidency? 

A  My agenda is mainly just serving my fellow physicians in the best way I can. You know, I think we’ve really taken it on the chin with COVID. For two years there have been challenges from appropriate equipment shortages to a lot of garbage on the internet that has been very misleading. So my main goal for this year is for us as physicians to reclaim trust, to try to unify better, to try to communicate better, and try to find the common issues that we need to stress and push that really impact our patients. Also, to protect the autonomy of the patient-physician relationship however we can so physicians can address issues comfortably without either [patients or physicians] fearing interference from any of those other entities, be it government, be it insurance, be it hospital – whatever.

Q  That concern is definitely a top issue. So what would you tell someone who is right at the beginning of their career, or the beginning of their involvement with organized medicine?

A  For any physician just starting it’s really important for them to know who they are, so they have to have a support base. And for me that starts with faith, with my faith in the Lord. For them it may be something else, I don’t know, but I think that has really helped ground me. The other part of that is my family; they keep you grounded, and they keep it real. And then joining in with colleagues. Being not just a participant or a member but being and getting involved in organized medicine. 

There’s a lot to be done. We have a lot of committees and councils that are doing excellent work and it’s finding what’s important to you and making the time. You literally have to make the time to get involved. You sacrifice some family time and time working in your practice. So you have to be aware of that; you have to plan. But I just can’t encourage people enough, to know how rewarding and how worthwhile it is to make that time to join with your other colleagues and be involved in organized medicine and join the leadership team.

Q  So looking at this next year, it’s a very exciting time for you. You’ve had a great career; you got to help a lot of people in both practice and in organized medicine, but now you’re starting something new. Do you have anything you’d like the physicians of Tarrant County to keep in mind this next year?

A  One thing I would say, not only to the Tarrant County physicians but those throughout the state, is to stick to issues. State opinions about issues, but insulting public officials is never going to get us anywhere, not even into compromised territory. Call me, call [TCMS CEO] Brian Swift, get it off your chest. But don’t put it out on social media; it rarely achieves anything. 

For the folks in Tarrant County, I know practice and family and faith life are demanding, but I am an example that you can do organized medicine with all of that. I would encourage you to show up. Just come. The biggest part of getting involved is showing up. We are always looking for people to serve on committees and councils. I didn’t do anything special; I don’t have any special knowledge. The experiences I’ve gained are because I’ve shown up. It’s important to be involved now, because the practice of medicine is being challenged in many ways, and it is your chance to make a difference for your practice and your patients. So show up; you’ll be glad you did.  

In our next issue, you will again hear from Dr. Floyd as he reports on his experience as TMA president and highlights TMA’s top priorities.