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PPE Distributed to Fort Worth-Area Physicians

By David Doolittle

Originally published on the Texas Medical Association website.

Some North Texas physicians are about to receive desperately needed personal protective equipment (PPE) thanks to a partnership between the Texas Medical Association, the Tarrant County Medical Society, and the North Texas Regional Advisory Council (RAC).

The county medical society received a shipment of PPE from the RAC on Saturday that will be distributed to area physicians based on their practices’ needs, CEO Brian Swift said.

“This has been a team effort – everyone from the TMA, the RACs, and the doctors’ offices – to get these supplies where they need to go,” Mr. Swift said. “In North Texas, it’s been tough sledding for weeks, but it’s finally getting worked out.”

The collaboration, which began last week, is part of an effort to distribute PPE to the state’s community physicians, who have grown increasingly desperate for the protective equipment they need to care safely for patients.

Under the program, physicians indicate their PPE needs through an online portal created by TMA, which will forward that data regularly through eight designated Hospital Preparedness Programs (HPPs) and RACs. The RACS and HPPs will make the supplies available for county medical societies and other organizations to distribute.

That’s what happened Saturday, when Mr. Swift received word that the North Texas RAC in Arlington had PPE available for physicians in Tarrant County, as well as nearby Parker and Johnson counties.

“I rented a U-Haul van, drove to Arlington and pulled up to the RAC,” Mr. Swift said. “There were two National Guard guys there who helped me load the PPE. I drove it back to our headquarters and returned the truck. It took about three hours total.”

The supplies include K95 masks, surgical masks, and face shields, which will be added to several thousand N95 and surgical masks that MedStar Ambulance service donated to the society a few weeks ago, Mr. Swift said.

Society officials have been contacting area physicians with instructions on when and how to pick up the PPE, he said.

“They’re just grateful, the staffs, the nurses, they’re excited to have it,” he said. “It’s great because we get to meet a bunch of new people.”

The portal is not a PPE order form. The amount and type of PPE in state warehouses varies each week. Submitting a form does not guarantee practices will receive supplies. Physicians whose data indicates a need for PPE will be placed on a distribution list to receive supplies as they become available.

To ensure each practice submits only one set of data to the PPE Portal, not all Texas physicians have received personalized login credentials. If you did not receive the credentials via email, check with your practice manager or the lead physician in your practice. Practices with multiple locations are considered a single practice. If it appears that no physician at your practice received the credentials, please contact the TMA Knowledge Center at (800) 880-7955 or by email.

For more details, see the TMA PPE Distribution Q&A document.

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

Help TMA Get PPE to Your Practice

As the Texas Medical Association told you Monday, personal protective equipment (PPE) will begin to move more quickly from state-managed warehouses to Texas county medical societies and on to private practice, community care physicians.

The movement of PPE, including N95 masks, is possible through an extensive collaboration among TMA, county medical societies, and a host of other associations and state agencies.

But we need your help.

Check your email today for a personalized link to the new TMA PPE Portal, which will include a needs assessment form for your practice. The form asks you to report your daily use of N95 masks, surgical masks, gloves, gowns, face shields, booties, and sanitizer. Only one email was sent to each practice.

Find more information, including who can request PPE through the portal, how much it will cost (spoiler alert: it’s free), quality control, and how to identify your Regional Advisory Council (RAC), in TMA’s latest PPE frequently asked questions (FAQ) document.

Remember that the portal is not a PPE order form. The Hospital Preparedness Programs (HPPs) and RACs will use the data to allocate a share of available PPE to county medical societies. The county societies will use the data and guidelines developed by a TMA work group to distribute PPE to community physicians.

“The RACs and HPPs are all independent organizations, and all operate differently. Thanks to the strong support of Chief Nim Kidd of the Texas Division of Emergency Management, everyone is working much better to meet the PPE needs of community physicians,” TMA President David C. Fleeger, MD, said. “We very much appreciate the assistance of Chief Kidd and the RACs.”

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

TMA Supports Governor’s Science-Based Plan to Reopen Texas

Statement by Texas Medical Association (TMA) President David C. Fleeger, MD, about Texas Gov. Greg Abbott’s announcement on reopening Texas.


“Texas physicians are pleased that Governor Abbott is taking a gradual, science-based approach to reopen the Texas economy safely. We applaud the governor for placing four outstanding physicians on his recovery strike force and for stating in such a straight-forward manner, ‘We must be guided by the data and the doctors. We must put health and safety first.’

“We obviously look forward to the safe reopening of those portions of our health care system that have been shuttered as we took the steps necessary to slow the spread of this virus. The health of patients not affected by COVID-19 is an overwhelming concern. Telemedicine has been an important tool, but it does not substitute for hands-on examinations of growing children or diagnosing complex health problems. Many of our patients have put off desperately needed surgeries or procedures that can no longer be delayed.

“We cannot throw the switch overnight, however, or we risk a rapid return of a terribly contagious disease that has not yet reached its peak and is still killing dozens of Texans every day. Moving forward on safely reopening our state will require:

  1. Ongoing and consistent compliance with the social distancing practices that have worked so well, so far, at containing the virus in Texas;
  2. Reliable, affordable and widely available testing for our patients, physicians and other health care personnel, and those who have come in contact with COVID-19-positive patients, so we can identify and contain new cases as quickly as possible;
  3. Appropriate personal protective equipment (PPE) for non-hospital based/community physicians, nearly two-thirds of whom say they have less than one week’s supply of the most critical supplies, according to a TMA survey conducted late last week;
  4. A huge immediate expansion in our state and local public health infrastructure and workforce so we can track down, isolate, and monitor Texans newly infected with this virus – and anyone who may have contracted it from them; and
  5. A way to cover the health care costs of the millions of Texans who don’t have or recently lost health insurance.

“We appreciate that Governor Abbott has solicited the experts and listened to their advice. We must follow the science. We need to have adequate PPE, and we’re not there yet. We need to have adequate testing, and that’s not available yet in physician offices or in the wider community. And we need to have the ability to track down positive cases based on those tests, something our overextended public health system won’t be able to do in the immediate future.

“Patience has been a critical factor behind our successes so far. We must remain patient, calm, and vigilant. Until we have a vaccine, social distancing remains the best way to reduce the spread of COVID-19. As the governor said, we must make sure we don’t reopen only to have to shut down again.”

House of Delegates Meeting and Contested Elections Postponed

Due to the evolving COVID-19 pandemic and its effect on the ability of the TMA House of Delegates to discharge its duties, the TMA Board of Trustees called itself into session on March 29, 2020, to function as a Disaster Board.

TMA Bylaws 4.202

Function as disaster board. In the event a catastrophe of national proportions such as war prevents the House of Delegates from acting, the Board of Trustees shall have the authority to receive and act on the reports of officers, boards, councils, and committees; to legislate; to elect and install officers; and to approve the president-elect’s nominees for council positions in accordance with regulations applying to the House of Delegates. In case of national catastrophe, the Board of Trustees shall be considered a disaster board and shall be called into session.

To keep our members’ focus on the escalating health crisis and predicted surge, the Disaster Board voted on April 5, 2020, to suspend the 2020 TMA House of Delegates meeting, either virtual or in-person, until an appropriate time in the future when the crisis has subsided.

The Disaster Board still feels it is essential to transition TMA leadership to allow our organization to move forward appropriately and deliberately. The board will soon proceed with transitioning President David C. Fleeger, MD, to immediate past president, and President-elect Diana L. Fite, MD, to president.

For the uncontested positions, the Disaster Board polled the caucus chairs, who provided no further nominations. The Disaster Board will move forward with electing these uncontested candidates by acclamation.

The uncontested positions are:

  1. E. Linda Villarreal, MD, for president-elect
  2. Arlo F. Weltge, MD, for speaker
  3. Bradford W. Holland, MD, for vice speaker
  4. Michelle A. Berger, MD, for secretary/treasurer
  5. All uncontested Texas Delegation to the AMA positions

All contested elections are postponed until the Disaster Board determines the health crisis has concluded and the House of Delegates is able to function.

To keep a steady hand at the helm of TMA during this uncertain time, the board members whose terms were set to expire after TexMed 2020 will continue to serve on the board until such time as voting through direct ballot by the full House of Delegates can occur.

This extension applies to the following board members:

  1. G. Ray Callas, MD, at-large trustee
  2. Gary W. Floyd, MD, at-large trustee
  3. Lindsay K. Botsford, MD, young physician trustee
  4. Douglas W. Curran, MD, immediate past president, will fill the vacancy created by Dr. Villarreal’s transition from at-large trustee to president-elect

Once the Disaster Board returns authority to the House of Delegates at the end of the crisis, Dr. Curran will transition off the board and elections will be held for the three at-large positions and the young physician trustee position, as well as contested elections for alternate delegate to the Texas Delegation to the AMA.

Your Disaster Board is very much aware of the many serious problems you now face, including maintaining the viability of your practice and obtaining personal protective equipment. The entire TMA family is working hard each and every day to address those issues.

Practice Viability Toolkit

The COVID-19 pandemic has critically impacted medical practices. To help you make important decisions for your practice, TMA released a Practice Viability Toolkit that provides the most up-to-date information and resources available. The toolkit addresses a number of issues:

  1. Telemedicine, with information about technology, HIPAA relaxations, prescribing, coding and billing, and policies and procedures;
  2. Cash flow, including Small Business Administration loan assistance, lines of credit, payment deferrals, loan refinancing, and loans from private banks;
  3. Payers, coding, and documentation information, including Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP), commercial plans, workers’ comp, and claims submissions;
  4. Human resources, including wages and hours, the Families First Coronavirus Response Act, and termination and unemployment benefits; and
  5. Advocacy, such as mass critical care guidelines, non-urgent, elective surgeries and procedures, the Coronavirus Aid, Relief, and Economic Security Act (CARES Act), payment parity for telemedicine services, liability protection, and stay-at-home guidance.

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.

Updated TMA White Paper Explains Non-Urgent Surgeries Rule

Worried, concerned, confused about the Texas Medical Board’s emergency rules on “non-urgent elective surgeries or procedures” during the COVID-19 crisis? What about the new FAQ the board issued over the weekend? You’re not alone.

Many Texas physicians have called the Texas Medical Association about the rules.

If you’re uncertain about what are considered non-urgent, elective surgeries and procedures – as well as what you or your practice will be required to report – TMA’s Office of the General Counsel produced this white paper to help you better understand the emergency rules.

In addition, the TMA COVID-19 Task Force has created a document that provides links to COVID-19 resources, including state and federal guidance as well as specialty societies that have published resource pages.

PPE Supply and Shortage FAQ Answered by TMA’s COVID-19 Task Force

One of the biggest obstacles physicians are facing in the COVID-19 pandemic is a lack of access to personal protective equipment (PPE). The TMA COVID-19 Task Force has worked to compile a list to answer the most common PPE questions. Read the PPE Supply and Shortage FAQ to find out more information, from conservation strategies to the best course of action if N95 respirators or face masks are not available.

AMA’s ROLE IN COVID-19 PANDEMIC

The following is a message from American Medical Association EVP/CEO James L. Madara, MD. 

The COVID-19 pandemic represents an enormous threat to public health and an extreme challenge to physicians. Now, more than ever, physicians need a powerful ally in patient care. The AMA’s COVID-19 response strategy, attached, provides a road map for our initiatives in an unprecedented pandemic scenario. The strategy frames the AMA’s response in three key areas:

  • Providing clear, evidence-based guidance from trusted resources, including JAMA Network, the CDC, WHO, state and local agencies and AMA subject matter experts.
  • Building an interface with physicians on the front line, allowing them to share their experience with other physicians, the government and key health agencies.
  • Removing obstacles to diagnosis and treatment through our Advocacy, CPT, PS2 and other initiatives.

We are acquiring many ideas and we filter them through the above three strategic channels (keeping in mind the overarching view of what it is the AMA does well). Since early January, we have closely monitored the global outbreak of COVID-19 and compiled up-to-the-moment information for physicians. Here are some examples of what we’ve done recently viewed through the lens of our COVID-19 response strategy:

  • Building an interface with physicians on the front lines
    • Speaking directly to power on behalf of physicians
    • Conversations and updates with our Federation partners and AMA Ambassadors
    • Learning from and sharing first-hand accounts of physicians on the front lines. Listen to JAMA Editor Howard Bauchner, MD interview Maurizio Cecconi, MD in Italy and NIAID’s Anthony Fauci, MD;  read how the Permanente Medical Group developed new approaches to preserve PPE. 
    • Listening to and answering questions from physicians on twitter, leveraging ambassadors to engage and spread the word, and will be conducting Twitter chats to answer physician questions and share experiences. 
    • Called on the Administration for $100 billion dollars to support front line health care personnel and providers.
  • Removing obstacles to diagnosis and treatment
  • AMA Head: Lack of protective gear for health care workers is ‘unacceptable’
  • AMA Calls on Administration to Use Every Lever to Address Protective Equipment Needs, Lack of Tests in COVID-19 Fight
  • Mobilizing a dramatic increase in the nation’s telemedicine capacity through its advocacy and publication of the Quick Guide to Telemedicine in Practice, a new resource to help physicians implement remote care.
  • Developed new CPT code for coronavirus.
  • Eased restrictions on the use of laboratory developed tests for COVID-19 testing to expand local access. 
  • Administration exercising flexibility in reducing regulatory burdens by allowing physicians to care for Medicare beneficiaries in States other than where they are licensed, waiving enrollment requirements and expediting enrollment, and waiving the requirement for Medicare patients for a 3-day hospitalization prior to covering skilled nursing facility care.  
  • Worked with HHS on the development of new recommendations for deferring non-urgent elective procedures that are consistent with recommendations of the American College of Surgeons. 

The AMA’s COVID-19 news and video coverage is promoted across the AMA website, email, Morning Rounds, all social platforms and Apple News. Since COVID-19 coverage began through March 18, nearly 390,000 users have consumed COVID-19 content from the AMA website, including nearly 17,000 clicks/referrals to JAMA and EdHub resources.

Resources

AMA Letters:

  • March 19  Letter to Congressional Leaders re: urgent steps to help preserve viability of physician practices due to the demands of COVID-19.
  • March 18  Letter to Seema Verma re: CPT code clarification in light of COVID-19 with remote physiologic monitoring and telephone evaluation and management.
  • March 16  Letter to Michael Pence re: Request for assistance with shortage of personal protective equipment for health care professionals.
  • March 13  Letter to Alex Azar re: Medicare assistance for solutions facing the nation with the COVID-19 outbreak.

Sign-On Letters:

Press releases to date:

March 20:

March 19:

March 18:

March 17:

March 13:

March 10:

March 5:AMA statement on Congress passing supplemental COVID-19 appropriations