Lights in the Dark

by Angela Self, TCMS President

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


I once wrote about my hopes for life after medical school. I would imagine my office decor, my conversations with patients, the time I would spend coordinating their care. The thoughts were all happy and gave me hope when the dark days of medical school cast a shadow over my upbeat mood, when classes took me down the road of insomnia and gave me a near flat affect from studying more than 12 hours a day during exam time. I guess we all looked like zombies immediately before and after our exams, and some even had the fragrance. 

Once a girlfriend came to visit me and she stayed at a hotel on the beach. I discovered the pleasure of sitting and enjoying a piña colada and having zero thoughts of gluconeogenesis or small, slow-conducting fibers (protopathic). Denise, the Coyaba hotel, and a piña colada were all little lights for a med student who was over 2,000 miles from home.

There are times during my professional life that I once again feel like I’m over 2,000 miles from home. Denise is now married and living in Ohio. Piña coladas have way too many calories. The Coyaba hotel would require more PTO than I’m able to take. I’m sitting at my dining room table as I write this because stepping back into the office would make me feel like I’m still at work. I started to take an evening walk but turned around when a close friend told me how much my article sucked (the one you’re not going to read). He didn’t actually say that it sucked; he just pointed out how opposite of uplifting or encouraging it was and said, “It’s not your best work.” Thank you, “D,” for your honesty.
  

Why would I not be the happiest person you could meet? I have a great job. I am happily single and able to go out and meet a girlfriend for coffee any time I want. I see my beautiful daughter on a regular basis (who is working, doing well in school, and enjoying her youth by spending time with her close friends). My mom survived a hospitalization that nearly took her life in 2013 and has never smoked again (I had taken her home on hospice ten days after she was admitted). Heck, I barely have enough bills to qualify as debt. I should be dancing around the whole Grapevine/Colleyville area. But I’m not.

The strange thing about being there for everyone else is that you sometimes forget to keep a little piece of yourself to enjoy—you just give it all away. Yes, this is a “me” problem. I am the one who picks up the phone when I know the person calling is going to vent for the next 30 minutes, but after 20 years of friendship, you make an effort to still “be there” because that’s what friends do. When your very best friend calls and frantically asks for prayer because the vet is coming to put their horse down (which happened two days ago), how do you not take that call? When your mom wants to tell you about a grandkid she’s concerned about and says the stress is overwhelming, are you going to hang up on her? Another friend tells you they are really concerned because they are still having fatigue and shortness of breath since their heart procedure—and this is one of your health-conscious friends. How can you not feel that? Then there is the job that you love doing, but sadly you do it for 12 hours many days. I find myself on long walks, asking, “Am I missing something?” I wonder if there are elderly patients that I could be helping, or if I’m not fulfilling my calling by now being on the “administrative” side of Medicine.

Long walks, good coffee, and two cats have replaced Denise, the Coyaba, and even the piña colada. As I walk along, I play music from the 80s and 90s and look at all of the different trees—I love the long needle pines the best, they look and smell good. I see the cardinals and the other birds flying around and admire how they know the meaning of commitment. On the weekends I spend hours at the coffee shop with the same few people I’ve been meeting there for years (none of us got COVID-19, and almost everyone is getting vaccinated). They give me a special discount at Buon Giorno, just don’t tell anyone. What? They give everyone that same discount for bringing their thermal mug? I look up at the stars and try to find the big dipper, but I live in Grapevine and, you know, light pollution. I run a hot bath and sit there until it’s barely warm. Netflix holds many fond memories from my COVID-19 nights: Shtisel, Sex and the City, The Crown, Girlfriends . . . I really do make the most of each day and try to laugh as much as I can. It’s just been hard to laugh lately, and I wanted to share in case someone else is also having a hard time laughing, or sleeping, or even folding the laundry.

We are the ones who are there for everyone else. Who is there for us? Though my friends and family can drain the very life force from my body, I want you to know that I am here for you. You have sacrificed so much for others, and your colleagues see you. They care even though you thought they didn’t like you. I am struggling a bit these days, as I suspect many of us are after the year we’ve been through. 

Perhaps this is just my COVID-19 carb crash, but I am ready for this season to end. I am praying; I like to pray. I am even going to church on occasion . . . not that I care for going to church. But my faith has always seen me through the most difficult of times, and I once again find myself reading Joshua 1:9, knowing that He will be with me wherever I go. I am going to put that and a few other verses on the wall behind my laptop as a reminder that He is always with me. I have friends who do not share my faith, my politics, or my taste in music, but we do share the need to connect, to laugh, and to be heard. Thank you for reading my article and for being one of the lights in a sometimes dark place. Call me any time at 817-798-8087 (text first if you actually want me to pick up). We’re all walking through this—let’s do it together. 

This Can Help Your Practice’s Revenue During COVID-19

This was published by Texas Medical Association. You can read the original version here.

This is not business as usual. The COVID-19 pandemic has affected physician practices both clinically and economically. 

You may already have made changes in how you care for patients, such as utilizing telemedicine in place of in-person visits. 

For a big picture perspective, Catalyst Health Network, a clinically integrated primary care network, has created a financial workbook you can download that calculates the effect a decrease in patient encounters and revenue has on your practice. 

You also can make adjustments in operating expenses that can keep your practice’s finances healthy. 

According to the Medical Group Management Association (MGMA) benchmark data, staff salaries and building occupancy are the two largest expenses in a physician practice. Staffing alone typically accounts for 25% of total operating expenses, and leases account for another 6% to 10%. 

However, these can be difficult sums to change: We want to support our staff, and we need to maintain an office space. 

There are other fixed expenses, like insurance payments, that may be deferred but not necessarily adjusted. However, there are some things you can do: 

Lease: Contact your landlord to discuss a deferment of monthly payments. If you are in your renewal period, negotiate a deal that includes a lower payment and/or deferment for the first few months of the new lease. 

Staffing: There are a few options like layoffs or furloughs, but be sure to consider your future funding needs as your decision could have an impact on loan forgiveness. If you furlough, you still need to pay for benefits. Furloughed staff are eligible to apply for unemployment as well. You also can consider rotating staff if you have patient care or billing needs to fulfill. 

Supplies: Stop automatic orders so you can have more control over which medical and office supplies you pay for. Consider joining a group purchasing organization (GPO) for pricing considerations if you are not already a member. 

Equipment leasing: Contact your vendors for any assistance they could provide during the current crisis. Your vendors might be able to defer or lower payments for a period of time. Evaluate use of equipment to determine if it is truly necessary to your practice. If not, return it and eliminate a payment. 

Subscriptions: Suspend any magazine or other unnecessary subscriptions. 

Shredding/Biohazard/Laundry Services: Suspend services you are currently not using. 

On the income side, Catalyst Health Network also has created a tool that compares the Small Business Association’s (SBA) lending options: Express Loan, the Paycheck Protection Program, and Economic Injury Disaster Loans. The tool has information on when and where to apply, the qualification requirements, and other pertinent details. 

The Texas Medical Association Practice Viability webpage includes more information and resources to help keep your practice afloat, including frequently asked questions (FAQs) on practice viability and human resources issues. 

Remember, you can find the latest news, resources, and government guidance on the coronavirus outbreak by visiting TMA’s COVID-19 Resource Center regularly.

PHYSICIANS NEEDED FOR TASK FORCE

TCMS is organizing a Physician Task Force to supplement community hospitals at this critical time. We need your support – please join this effort on the front lines of the coronavirus pandemic.

If you are interested in volunteering, fill out this form and contact Brian Swift at (312) 330-4894 or bswift@tcms.org.

Blood Drive at Carter BloodCare: Rosedale Donor Center

Moncrief Cancer Institute has teamed up with Carter BloodCare to host a blood drive on Sunday, March 29 from 9 a.m. to 3 p.m. at the Rosedale Donor Center. This is considered an essential activity and is approved by the City of Fort Worth. We need the community’s help to keep the blood supply ready. 

Sunday, March 29 from 9 a.m. to 3 p.m
Carter Bloodcare: Rosedale Donor Center
1263 W. Rosedale
Fort Worth, TX 76104

Click this link to sign up – must pre-register to honor social distancing! On the day of the blood drive, donors will receive a link to a short, online questionnaire to complete.

Carter BloodCare donors help provide blood for 90% of the hospitals in North, Central, and East Texas, and their supply has decreased due to drives/appointments being canceled. Blood is needed for cancer patients, transplant recipients, heart surgery, and trauma. Giving blood is safe, and Carter BloodCare is taking all precautions to ensure the safety of the donors. The team wears personal protective equipment throughout the entire blood drive and exceeds all FDA guidelines.

Tarrant County COVID-19 Activity 3/25/20

Data from Tarrant County Public Heath’s (TCPH) report of COVID-19 activity in Tarrant County, updated Wednesday, March 25, 2020 at 11:30 a.m. Find more COVID-19 information from TCPH here.

Source:http://www.tarrantcounty.com/en/public-health/disease-control—prevention/coronaviruas.html?linklocation=homecarousel&linkname=COVID-19

COVID-19 Drive Thru Testing Available for Health Care Workers

The Tarrant County Medical Society is pleased to announce that the City of Fort Worth Fire Department, in close consultation with Dr. Michael Williams, President, UNTHSC at Fort Worth and Dr. Keith Argenbright, Director, Moncrief Cancer Institute/UT Southwestern Medical Center have opened a COVID-19 testing center for 1st responders that is now available to front line health care workers. This screening resource is now available for physicians, nurses, medical assistants and other health professionals who are on the front lines fighting the COVID virus.  

If you are interested in accessing this testing, please call the Infections Disease Coordinator at the Joint Emergency Operations Center (EOC) at the City of Fort Worth at 817-714-9709. This number is answered from 8 am to 5 pm daily. The ID coordinator will conduct an environmental and clinical assessment of the health care professional and determine if COVID testing is warranted. We understand that the clinical evaluation of COVID testing is complex and changes rapidly – you can be assured that the IC coordinator is up-to-date on the current recommendations. 

If testing is indicated, the ID coordinator will collect demographic and clinical information from the health care professional and give the provider the address of the testing facility and an appointment window. The ID coordinator will inform the professional that if the result is positive, they will receive the results by phone; if negative by text or e-mail. The health care professional will be given post-test instructions, including self-quarantine until the test results are available. We are telling them to expect 5 days for results, but are hoping for a quicker turn-around. 

We appreciate your cooperation in this effort to quickly and appropriately screen our critical health care providers. This is a new program and thus will be subject to modification as it is operationalized. 

Dedicated Cellular Network Open to Physicians Responding to COVID-19

Physicians and other licensed health care professionals are now eligible to join FirstNet, the nation’s only public safety wireless broadband network.

FirstNet, built and maintained by AT&T with first responders and for responders, provides nationwide 4G LTE wireless voice and data. The FirstNet network features First Priority® that supports prioritized and efficient communications, as well as preemptive access to network resources for first responders during times of congestion. This helps ensure fast, efficient, and highly secure communications flow for those on the front lines responding to the COVID-19 pandemic.   

Telehealth applications, which often require video and photos, are data intensive. The data prioritization on FirstNet helps to address that.

FirstNet was commissioned by Congress as a single, nationwide wireless broadband network in response to the communication failures that occurred during the 9/11 terrorist attacks. FirstNet is government authorized, inspected, and supervised, holding AT&T accountable to keeping first responders’ lines of communication open with dedicated mission critical solutions.

Physicians can join or switch to the network at a discounted rate, which includes unlimited data and no throttling. You can register on the FirstNet website, which includes more information on the network. You can also visit an AT&T store and show your credentials (such as a hospital badge or paystub). If you are with another carrier, early termination fees may apply from that carrier.

Remember, you can find the latest news, resources, and government guidance on the coronavirus outbreak by visiting the Texas Medical Association’s COVID-19 Resource Center regularly.

CMS Postpones 2019 MIPS Reporting Deadline to April 30

By Joey Berlin

Originally published on the Texas Medical Association website.

With a key deadline for clinicians in the Merit-Based Incentive Payment System (MIPS) approaching fast amid the COVID-19 pandemic, the Centers for Medicare & Medicaid Services (CMS) is giving those clinicians a month of extra time to submit their data.

CMS announced Sunday it is moving the deadline for MIPS-eligible clinicians to submit their 2019 MIPS data to April 30, instead of March 31.

Even if that’s not enough time, not submitting your data by then won’t hurt your bottom line. CMS also announced that MIPS-eligible clinicians who haven’t submitted their 2019 data by the April 30 date would simply receive a “neutral payment adjustment” – that is, no payment bonus and no 7% penalty – in calendar year 2021. (MIPS bonuses or penalties for a given performance year are assessed two years later.)

MIPS is a key piece of the agency’s Quality Payment Program, which requires eligible clinicians to participate in the program either through MIPS or alternative payment models.

CMS announced the MIPS extension among a host of new measures under its “extreme and uncontrollable circumstances” policy in order to ease the burden on clinicians participating in a number of federal quality reporting programs.

“In granting these exceptions and extensions, CMS is supporting clinicians fighting coronavirus on the front lines,” CMS Administrator Seema Verma said in a release. “The Trump administration is cutting bureaucratic red tape so the health care delivery system can direct its time and resources toward caring for patients.”

Any clinicians who have already submitted their 2019 MIPS data, or submit their data by the April 30 deadline, will be scored and receive a payment adjustment under the normal method, CMS said. April 30 is also the new deadline for clinicians to revise their submitted data, if needed, by logging in to the QPP portal. For guidance on submitting your data, download this CMS guide (PDF).

CMS also reports it is evaluating options for providing additional relief for the 2020 QPP performance year (which would affect 2022 payments). Texas Medicine Today will update physicians when CMS releases more information.

The list of new exceptions and extensions for the QPP and other federal quality reporting programs is available here.

For questions, contact the QPP Service Center at (866) 288-8292 or by email.

Remember, you can find the latest news, resources, and government guidance on the coronavirus outbreak by visiting TMA’s COVID-19 Resource Center regularly.