Lubbock Crosby Garza County Medical Society

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Summary of 2010 Annual Session of the House of Delegates

TMA President Sue Bailey, MD, took office on Saturday, May 1, 2010, at a critical juncture in American medicine. She pledged to lead TMA in a campaign to “take advantage of change” brought about by the new health reform law. “We will use the health system reform bill as a catalyst to help us identify what needs to be done on Capitol Hill, in Austin, and in our own offices to make sure our patients have access to excellent care,” Dr. Bailey said. “We will use the health system reform bill as a catalyst to make sure that our practices stay viable. We will use the health system reform bill as a catalyst to make sure physicians have the autonomy to make decisions that are in our patients’ best interests.” Joining Dr. Bailey in the “all-Tarrant County” installation was new TMA Alliance President Doris Johnson of Roanoke. “I see opportunities for growth and even greater service to Texas and can’t wait to get started,” Mrs. Johnson said.

The TMA House of Delegates unanimously chose Austin orthopedic surgeon Bruce Malone, MD, as the association’s president-elect. He will take office at TexMed 2011 in Houston next spring. “My focus will be to protect the patient-physician relationship and strengthen the viability of Texas physicians’ practices in this era of health care reform,” Dr. Malone said. In other elections:

The house reelected House Speaker Steve Brotherton, MD, of Fort Worth and Vice Speaker Cliff Moy, MD, of Austin.

Delegates reelected Tom Garcia, MD, of Houston to the TMA Board of Trustees, and elected new trustees Doug Curran, MD, of Athens and David Teuscher, MD, of Beaumont. The new resident member of the board is Travis Bias, MD, of Houston, and the new student member is Gavin Roddy from Texas A&M Health Science Center College of Medicine. The board later chose Carolyn Evans, MD, of Dallas as its chair; Dr. Garcia as vice chair; Dr. Curran as secretary; and Carlos Cardenas, MD, of McAllen and Lewis Foxhall, MD, of Houston as members of the executive committee.

The house chose Brad Butler, MD, of Longview and Michael Ragain, MD, of Lubbock as the newest physicians on the Texas Delegation to the American Medical Association. The Resident and Fellow Section chose Bret Beavers, MD, of Fort Worth, and the Medical Student Section selected Stephanie Howe of Houston. The house also reelected 15 members of the delegation.

The new president of the TMA 50 Year Club is Larry Stone, MD, of Austin.
The TMA Alliance chose Bridget McKeever of Corpus Christi as its president-elect.

Not only has Ladon Homer, MD, of Fort Worth held almost every key leadership position in TMA, TEXPAC, the Tarrant County Medical Society, and the Texas Society of Pathologists, but also he fathered two active TMA physician members and married a lady who went on to be president of both the TMA Alliance and the AMA Alliance. For all of that dedication and more, TMA gave Dr. Homer the Distinguished Service Award, our highest honor. Dr. Homer told the house the award was one of the most wonderful he had ever received. He cited the role his wife, Mary Ann, played in his professional life. “I want you all to know in many ways this a joint award, and today we are both very proud to accept this award,” Dr. Homer told the House of Delegates. In other awards:

Five members of the Texas family of medicine who serve in the U.S. Congress and Texas Legislature were the inaugural winners of our Champions of Medicine Award. They are U.S. Rep. Michael Burgess, MD (R-Lewisville); State Sen. Bob Deuell, MD (R-Greenville); and State Reps. Mark Shelton, MD (R-Fort Worth); John Zerwas, MD (R-Richmond); and Susan King (R-Abilene). Mrs. King is a TMA Alliance member. Watch their video interviews.
The Young Physician Section gave its Young at Heart Award to Glen Johnson, MD, and the Michael O’Malley, MD, Memorial Scholarship to Ashley Murray from Groom High School.

The Resident and Fellow Section gave the J.T. “Lamar” McNew, MD, Award to Kyle Morrow, MD.
The Medical Student Section gave the C. Frank Webber, MD, Award to Joel Dunnington, MD; named The University of Texas Medical School at Houston the chapter of the year; and gave the Student of the Year Award to Maryam Shambayati of Fort Worth.

Three outstanding Texas science teachers won the 2010 TMA Ernest and Sarah Butler Awards for Excellence in Science Teaching. The awards honor teachers who share their energy and enthusiasm for science through creative and innovative methods. This year’s winners are George Hademenos, PhD, of Richardson High School in Richardson, Lollie Garay of Redd School in Houston, and Nikki Skinner of Almeda Elementary School in Houston.

Nine Texas minority college students entering medical school each received a $5,000 scholarship at TexMed 2010. Since 1999, TMA has awarded scholarships to encourage outstanding minority students to enter medicine and help meet the medical needs of Texas’ diverse population. To date, TMA has awarded 56 scholarships, totaling $280,000. Generous physicians, county medical societies, and corporate donors finance the scholarships through the TMA Foundation.

The House of Delegates passed a resolution that TMA “continue to work with other medical organizations, with similar goals, to advocate for patients and physicians on a national level.” The house passed resolutions that support:

Changes to Medicare locality boundaries so payments reflect differences in local economic conditions;
Increased funding of mental illness and substance abuse treatment;
Higher pay for Medicaid physicians who treat patients after hours and on weekends;
Expansion in allopathic and osteopathic medical school enrollment;
Routine, evidence-based cancer screening;
Restored funding of statewide preceptorship programs; and
Vaccination against the human papillomavirus (HPV) of both young women and young men between ages of 9 and 26

The TMA House of Delegates efficiently dispatched more than 50 items on its agenda at its annual session at TexMed. Issues acted on by the house, grouped by the reference committee to which items were referred, are as follows:

REFERENCE COMMITTEE ON FINANCIAL AND ORGANIZATIONAL AFFAIRS

Recommendation to approve David G. Joseph, MD, Austin; Stuart D. McDonald, MD, Fort Worth; and John R. Holcomb, MD, San Antonio, nominees of the TMLT Board of Governors, to be placed before TMLT policyholders for election to the Board of Governors (Pres. Rep. 1). Adopted.

Recommendations to (1) discharge the Council on Public Health, (2) discharge the Council on Scientific Affairs, and (3) establish a new Council on Science and Public Health (BOT Rep. 12). Adopted.

Recommendation to delete policy on litigation guidelines (BOT Rep. 13). Adopted.

Recommendation to elect Tom S. McHorse, MD, to emeritus membership in the Texas Medical Association (BOD Rep. 3). Adopted.

Recommendation to approve Hector E. Morales, MD, Austin; Albert E. Gunn, MD, Houston; and Arthur M. Jansa, MD, Houston to honorary membership (BOC Rep. 4). Adopted.

Recommendation to retain policy on prescribing by pharmacists (BOC Rep. 5). Adopted.

Recommendation to urge medical specialty boards that automatically rescind the diplomate status of physicians enrolled in a state’s physician health program to review their policies, work with physician health programs around the country, and modify those policies to allow physicians in recovery to maintain their board certification on a case-by-case basis (CM-PHR Rep. 5). Adopted.

Recommendation to approve amendments to the Medical Student Section’s Operating Procedures (MSS Rep. 1). Adopted.

Recommendations to approve bylaws amendments changing the resident and student special appointee positions on the TMA Board of Trustees to member positions (CCB Rep. 1). Adopted.

Recommendations to approve bylaws amendments to (1) discharge the Council on Public Health and the Council on Scientific Affairs, (2) establish a new Council on Science and Public Health, (3) allow councils to have up to 15 members, and (4) bring the ethics requirement language for military members consistent with other categories of membership (CCB Rep. 2). Adopted.

Recommendation to approve a change to the charge of the Council on Health Promotion in TMA Bylaws. (CHP Rep. 2). Adopted.

Recommendation to adopt a substitute for current policy on health information technology and health information exchange to address the rapidly changing environment at the federal, state, and local levels (CPMS Rep. 2). Adopted.

Resolution that TMA communicate its appreciation for the value of medical student and resident participation in TMA and AMA meetings, and encourage medical school administrations and residency faculty to provide a mechanism through which students and residents may participate in meetings as an excused absence that does not represent allotted vacation time (Res. 101). Adopted.

Resolution that (1) an alternate delegate position be established on the TMA Delegation to the American Medical Association; and (2) that this be a one-year term position that is nominated by the Young Physician Section (Res. 102). Referred.

Resolution that TMA actively pursue any avenue to ensure that funding to the Texas Medical Board is maintained at the current level (Res. 103). Not adopted; reaffirmed existing policy.

Resolution that if TMA chooses to offer a members’ only, password-protected, interactive venue offering bilateral communication with its membership, such as a blog, that (except for generally accepted standards barring obscenity, civil rights violations, or incitement to riot) every good faith effort should be observed to accept and share dialogue from the membership, with a full disclaimer that the opinions expressed by the membership do not necessarily reflect the opinions of TMA or its Board of Trustees (Res. 104). Referred.

Resolution that TMA should join with other state organizations to consider alternate national physician organizations that represent the views of Texas physicians (Res. 105). Amended to read, “That the Texas Medical Association continue to work with other medical organizations, with similar goals, to advocate for patients and physicians on a national level.”

Resolution that physicians licensed to practice medicine in Texas shall attend a Texas Medical Association meeting within the first two years of practice, at which time they will attend an orientation meeting to learn the structure and operation of the association and all TMA departments available to assist them in their practice of medicine Res. 106). Amended to read, “That the Texas Medical Association contact newly licensed physicians in Texas and offer them an opportunity to receive an orientation at a county medical society, a meeting of the Texas Medical Association, or via an online tool to learn the structure, operation, and benefits of membership in the Texas Medical Association and our component county medical societies.”

Resolution that the Texas Medical Association request that the American Medical Association divest itself completely of all ownership rights of the Current Procedural Terminology coding system so that AMA can return to its proper function of representing the interests of its member physicians, free of the conflict of interest caused by ownership of the CPT coding system (Res. 107). Not adopted.

Resolution that TMA focus its efforts on analyzing the health system reform law, educating our physician members about its provisions and methods of adapting their practice to be viable and successful, and influencing the regulation process to bring the law closer to TMA’s Health Reform Principles and other TMA policy positions (Res. 108). Amended to read, “That TMA continue to focus its efforts on analyzing the health system reform law, improve education of our physician members about its provisions and methods of adapting their practice to be viable and successful, and continue advocacy for regulations that are consistent with TMA’s health reform principles and other TMA policy positions.”

REFERENCE COMMITTEE ON PUBLIC HEALTH

Recommendation that Resolution 203-A-09, Requiring Eye Care Provider Approval for Removal of Driver License Restriction, not be adopted (CPH Rep. 1). Adopted.

Recommendation that, in lieu of Resolution 208-A-09, the Texas Medical Association advocate reform of the federal Supplemental Nutrition Assistance Program (SNAP) before its constituent U.S. senators and representatives, as well as through its delegation to the American Medical Association, and support/advocate effective SNAP education programs about nutrition and physical activity to help influence overall positive food selections (CPH Rep. 2). Adopted.

Recommendations to (1) retain policy on blood alcohol levels and drug screens, bicycle helmets use of ANSI- or Snell- approved helmets, transporting injured athletes, football helmet use, and salt use in athletics; amend policy on impedance bridge mass school screening, Baby Moses Law, national drug policy, emergency room services to survivors of sexual assault, statewide emergency telephone system, ambulance certification, family planning and institutionalized individuals, poison control centers enhancements, family comes first, and family violence; and (2) delete policy on blood borne pathogen standard of OSHA, trauma regional centers, safety regulation enforcement, and violence prevention and intervention (CPH Rep. 3). Amended by addition and deletion so that Policies 55.018 and 55.032 read as follows:

55.018 Mass School Audiometric Screening: Mass screening of children in schools should be performed by pure-tone audiometry according to the recommendations of the American Academy of Pediatrics (Council on Public Health, p 91, A-95).

55.032 Baby Moses Law: The Texas Medical Association supports the Baby Moses Law which allows for the emergency possession of a child appearing to be 60 days old or younger who has been abandoned through the EMS system (Amended CM-EMS Rep. 3-I-00).

Recommendations that TMA (1) encourage females between ages 9 and 26 to get vaccinated against the human papillomavirus (HPV), and support the CDC and Prevention Advisory Committee on Immunization Practices’ recommendations of routine vaccination of females age 11 or 12 years with three doses of HPV vaccine. The vaccination series can be started beginning at age 9; and (2) use Texas Medicine and other resources to educate physicians on issues related to human papillomavirus, including current vaccine recommendations and cost effectiveness (CM-CAH Rep. 1). Amended recommendation 1 to read, “That our Texas Medical Association encourage females and males between ages 9 and 26 to receive the three-dose human papillomavirus vaccine series and support the American Congress of Obstetricians and Gynecologists, the American Academy of Pediatrics, the Centers for Disease Control and Prevention Advisory Committee on Immunization Practices, and the National Institutes of Health in recommending human papillomavirus immunizations. The three-dose vaccination series can be started beginning at age 9.”

Recommendations to adopt new policy (1) on HPV vaccine that TMA support the recommendations of the American College of Obstetricians and Gynecologists, the American Academy of Pediatricians, the Centers for Disease Control and Prevention, and the National Institutes of Health in recommending human papillomavirus immunization for individuals ages 9-26; and (2) on cancer screening that the Texas Medical Association supports the importance of providing routine, evidence-based cancer screening to average-risk Texans for primary cancer sites The decision to have regular cancer screenings should be in support of the full body of evidence and recommendation of professional health organizations that provide recommendations, and should take into account patient values regarding specific benefits and harms of any screening test (CM-C Rep. 1). Amended by deleting recommendation 1 and amending recommendation 2 to read, “Cancer Screening: The Texas Medical Association supports the importance of providing routine, evidence-based cancer screening to Texans. The decision to have regular cancer screenings should be in support of the full body of evidence and recommendation of professional health organizations that provide recommendations, and should take into account patient values regarding specific benefits and harms of any screening test.”

Recommendation that TMA request DSHS to develop a plan with a timeline outlining the state’s recommendations on improving the compatibility of ImmTrac and electronic health record systems used in physician offices; and advocate for resources dedicated to DSHS for improving the statewide immunization database so that immunization information can be readily transferred between ImmTrac and all physicians’ electronic health record systems (CM-CAH Rep. 2). Amended to read, “That our Texas Medical Association (1) request that the Texas Department of State Health Services (DSHS) develop a plan with a timeline outlining the state’s recommendations on improving the compatibility of ImmTrac and electronic health record systems; and (2) advocate for resources dedicated to DSHS for improving the statewide immunization database so that immunization information can be readily transferred between ImmTrac and all electronic health record systems.”

Recommendation that TMA cooperate with other associations, state agencies, and others to raise awareness and provide education on the dangers of fireworks to patients; and recommend age-appropriate fireworks education be included as a component of the Texas Health Steps program (CM-CAH Rep. 3). Adopted.

Recommendations to retain policy on comprehensive school health education in all school districts, human sexuality and family life as mandated health education curriculum, the right to confidential care, and sexually transmitted disease education; and (2) amend policy on adolescent sexual activity, adolescent health, and sexuality education (CM-CAH Rep. 4). Amended by addition and deletion so that Policies 55.004, 55.007, and 55.016, read as follows:

55.004 Adolescent Sexual Activity:

(1) The role of the physician — Physicians who treat adolescents have a responsibility to personally address or refer a patient with concerns related to sexual identity and positive self image. Comprehensive health care for adolescents must address issues related to reproductive history and sexual activity.

The following general principles should be considered by physicians in their discussions with adolescents and their families when appropriate.

Sexuality education. Physicians should help prepare parents to be effective sexuality educators for their children, encouraging them to communicate factual knowledge, family values, and behavioral expectations throughout childhood, especially during the critical transition years into early adolescence.

Confidentiality and consent. Physicians should be familiar with Texas laws regarding the adolescent’s right to reproductive health, assessment, and treatment for sexually related issues. Physicians also should be aware, in general, that the adolescent’s right to reproductive health has been upheld consistently in court either through specific statutes or the “mature minor” doctrine.

Adolescent reproductive health choices for sexually active teens. The healthiest and most effective way to prevent pregnancy and sexually transmitted infections in unmarried adolescents is abstinence. There is no contraceptive method that is 100 percent effective in preventing both pregnancy and infection, or is free of side effects. However, there are methods suitable for use by teenagers. Physicians caring for adolescents should be familiar with the most suitable contraceptive choices or be willing to refer to others who are.

Medical/lifestyle history. A thorough history is critical, as all sexually active adolescents are at risk for sexually transmitted diseases and unplanned pregnancies.

Sexual decision making with implications for self-esteem. As teenagers become interested in relationships, they need an opportunity to discuss sexual pressures, values, expectations, options, and consequences.

Sexual responsibility. Without being morally judgmental, the physician can help adolescents identify their own goals for safe and responsible sexual behavior.

Standards of practice. Physicians who treat adolescents should provide counseling and treatment or a referral for adolescent patients with respect to sexual development, sexually transmitted disease, birth control, and pregnancy.

(2) The role of the Texas Medical Association — TMA can contribute substantially to the promotion of adolescent health by (a) Sponsoring continuing medical education for physicians and health care providers at annual sessions and preparing reports and facilitating formal presentations concerning adolescent sexual activity; (b) Encouraging medical schools in the state to engage in research and training in all aspects of adolescent health, including adolescent sexuality; (c) Promoting interdisciplinary dialogue and networking on public health and public affairs issues involving the promotion of improved care for adolescents and comprehensive health education; (d) Utilizing Texas Medicine and other media as a forum for the promotion and discussion of all adolescent health issues including, but not exclusively concerned with, adolescent sexuality; (e) Developing educational materials (i.e., anticipatory guidance/discussion with parents); and (f) Serving as a resource to public schools and agencies creating programs and strategies to educate our youth.

(3) Legislative initiatives — (a) Local school districts should provide instruction on family life, human sexuality, and comprehensive health education for grades kindergarten through college level. Education should be age appropriate and should be taught by teachers who have received training in family life, human sexuality, and comprehensive health education; (b) The State of Texas should adopt in statutory form the “mature minor” doctrine and eliminate other statutory barriers to adolescents accessing health care; (c) TMA should support the following principles regarding adolescent pregnancy when it is the subject of legislation: (1) access to early and accurate diagnosis of pregnancy, (2) professional counseling describing the gestational alternatives, and (3) support of already existing TMA guidelines regarding abortion which base its performance on early and accurate diagnosis of pregnancy; informed and nonjudgmental counseling; prompt referral; skillful and understanding personnel working in a good facility; reasonable cost; and professional follow-up; (d) Funds at the state and local levels should be established for student-oriented primary care clinics and/or school-linked comprehensive health care for adolescents; and (e) Funding should be established for STD and AIDS research, treatment, and support services for adolescents (Council on Public Health, p 76, I-91; amended Res. 304-, 305-, and 306-A-01).

55.007 Adolescent Health and Substance Abuse:

Role of the physician. Physicians who treat adolescents should be prepared to personally address or refer patients with issues of substance abuse. Comprehensive health care for adolescents should include substance abuse prevention education and promotion of healthy lifestyles.

Role of the Texas Medical Association. (1) Sponsor continuing medical education programs for physicians and other health care providers, preparing reports, and facilitating formal presentations concerning adolescent health; (2) Encourage medical schools to engage in research and training in all aspects of adolescent health, including adolescent substance use; (3) Promote interdisciplinary dialogue and networking on public health and public affairs issues involving the promotion of improved care for adolescents and comprehensive health education; (4) Stay informed about programs aimed at high-risk youth; (5) Stay abreast of research on substance abuse; (6) Study the recommendations of the Texas Health Policy Task Force to ensure that adolescent needs are appropriately recognized and funded; (7) Encourage physicians to engage in preventive counseling with children and youth; (8) Support the surgeon general of the United States in efforts to improve adolescent health; (9) Support advertising of pro health messages to counteract tobacco and alcohol ads in print and electronic media.

Legislative initiatives. (1) Local school districts should provide uniform instruction and comprehensive health education for grades kindergarten through 12th grade on avoidance of tobacco, alcohol, and other drugs, including performance-enhancing drugs. Education should be age appropriate and taught by teachers who have specialized training in drug use prevention and health education; (2) Support establishment of school-based health clinics; (3) Encourage enforcement of laws related to drugs, alcohol, and tobacco; (4) Support all state efforts at rehabilitation of addicted youth; (5) Urge early identification of learning and behavior disorders (Council on Public Health, p 100, A-93; reaffirmed CM-CAH Rep. 2-A-03).

55.016 Sexuality Education: The Texas Medical Association supports age and developmentally appropriate comprehensive kindergarten through college sexuality education that is theory based, research based, and skills oriented. Effective curricula should focus on abstinence, avoidance of sexual risk-taking behaviors, availability of reproductive health choices, and information on responsible decision making, social influences, and peer pressures.

TMA should promote through visible and vocal leadership, to the state and other interested organizations and associations, its policy advocating comprehensive programs in sexuality education.

TMA will act as a resource and clearinghouse for scientific, medically accurate information on adolescent sexuality, dispelling medical misinformation, and for information on sexuality education programs.

TMA will continue to work with the Texas Education Agency and the state legislature to develop and implement curricula on sexuality education (e.g., education for self-responsibility).

TMA will monitor and encourage research on the effectiveness of different sexuality curricula.

TMA will actively seek community, business, and corporate support for this policy.

TMA will lead a coalition to promote comprehensive sexuality education in schools throughout Texas (Council on Public Health, p 106, and Res. 28N, p 172, A-94; reaffirmed CM-CAH Rep. 4-A-04).

Recommendations to replace four individual policies with one broader policy on obesity (CM-CAH Rep. 5). Amended so that Policy 260.007 reads as follows:

260.007 Obesity: TMA recognizes obesity as a serious public health problem. Approximately 66 percent of Texans are either overweight or obese, and nearly one-quarter of adolescents and children are overweight or obese. Obesity is a risk factor for heart disease, stroke, hypertension, diabetes, and some cancers. Obesity and the associated medical complications increase health care spending and patient morbidity and mortality.

Texas children now are in a health crisis, with the highest percentage of students with Type II diabetes, obesity, and heart disease in the history of our state. Forty-two percent of fourth graders, 39 percent of eighth graders and 36 percent of 11th graders were either overweight or obese, according to a survey of Texas school children in 2004 and 2005. Obesity in childhood increases the risk of obesity in adulthood. Obesity is the second most preventable cause of disease behind tobacco use.

The Texas Medical Association encourages physicians to become educated and empowered to conduct appropriate assessment and treatment of overweight patients and obesity in their practices and to serve as leaders in their communities and in the policymaking process to improve healthy eating and increased physical activity among our state’s children. The crisis results from a multitude of factors, including lack of physical activity, poor nutritional habits, and personal and societal responsibility. These issues require a multipronged response. TMA will monitor and encourages research on the medical, psychological, and social issues related to obesity in order to best inform recommendations on prevention and treatment.

TMA supports the need to educate Texas adults and children on the importance of proper diet, nutrition, and physical activity in the prevention and management of obesity. Specifically, TMA makes the following recommendations:

Coordinated School Health Programs

(1) TMA supports the development of a coordinated, comprehensive approach to child health through the schools. This includes integration of nutrition education into the K-12 school curriculum. TMA recommends school-aged children to receive at least 60 minutes of daily physical activity (30 minutes of which should be structured activity in a school setting). The program must provide for coordinating (a) health education, (b) physical education and physical activity, (c) nutrition services, and (d) parental involvement.

(2) TMA supports the replacement of foods and drinks with low nutritional value with food and drinks of documented value in promoting good nutrition in line with U.S. Department of Agriculture (USDA) recommendations. TMA supports the efforts of the Texas Department of Agriculture to enforce the USDA guidelines on Foods With Minimal Nutritional Value in schools and encourage the public to work with local schools to meet or exceed these guidelines.

Public Education

(3) TMA supports educating the general public, through the media or other available tools, on the benefits of maintaining a proper diet and adopting a schedule of daily physical activity.

(4) TMA supports public education on the clinical definition (body mass index — BMI) and the adverse consequences of obesity.

(5) TMA supports educating parents and preschool and day-care employees on the importance of proper nutrition and health nutritional choices for children starting at an early age.

(6) TMA supports a targeted initiative to communicate physical activity recommendations and supports increased physical activity among mid-life and older adults.

(7) TMA supports educational and other public health efforts to address obesity. These activities should focus on the need for people to consume smaller portions of food. Marketplace food portions have increased in size and now exceed federal standards. Portion sizes began to grow in the 1970s, rose sharply in the 1980s, and have continued in parallel with increasing body weights. TMA supports consuming breakfast as well as five servings of fruits/vegetables a day and foods with calcium and fiber. TMA supports family meals at home.

(8) TMA advises against having a TV in the bedroom and supports limiting screen time (computer, TV, video games) to fewer than two hours a day for children age 2 and older and to avoid screen time for children younger than age 2.

(9) TMA supports breastfeeding infants for at least six months, but encourages up to 12 months as infants who breastfed longer have lower incidences of obesity.

Public Policy Initiatives

(10) TMA supports local community initiatives that encourage physical activity, such as lighting parks and sports fields, promoting walking in the mall, etc.

(11) TMA should work with the public, legislators, and health payers to recognize that obesity is a serious medical condition that if untreated will cause significant morbidity and mortality. TMA encourages individual physicians, county medical societies, and alliances to support the establishment and growth of physical activity and nutrition programs in their communities such as local education programs on foods of minimal nutritional value.

(12) TMA should work with health plans to recognize obesity as a primary diagnosis and develop payment codes for physicians for prevention and treatment of obesity.

(13) Physicians should actively participate in their local school health advisory committees to promote awareness among parents and educators on the need to limit foods of minimal nutritional value in school meals.

Patient Assessment/Education

(14) Physicians should assess their patients for overweight and obesity (using BMI and nutritional status) during routine medical examinations and discuss with at-risk patients the health consequences of further weight gain; if treatment or counseling are indicated, physicians should encourage and facilitate weight maintenance or reduction efforts in their patients or refer them to a physician with expertise in the clinical management of obesity.

(15) TMA supports patient education and counseling on increased physical activity during each office visit.

(16) TMA supports cultural, ethnic, and language sensitivities when educating and counseling patients and families.

Physician Education

(17) Medical schools should be encouraged to teach medical students the essentials of obesity and the importance of maintaining an ideal body weight through proper dietary intake and regular exercise. Physicians should be the model of appropriate weight and health.

(18) Physicians should be trained in the proper assessment techniques for using BMI during routine medical examinations and “best practices” for facilitating weight maintenance or reduction efforts in their patients.

(19) Physicians should be up to date on current therapies such as, but not limited to, counseling, reinforcement, medication, and surgical options. (Resolution 28J, p 156, A-91; substitute CPH Rep. 4-A-03).

Recommendation that TMA the TMA Flu Fighters be recognized for their dedication to monitoring H1N1 guidance and information for physicians and for developing effective and efficient notices for physicians, and that this method of communication be used as a model in the future when physicians must stay informed on urgent public health threats (CM-ID Rep. 1). Amended to read, “That the Texas Medical Association recognize the TMA Flu Fighters for their dedication to monitoring H1N1 guidance and information for physicians and for developing effective and efficient notices for physicians, and that this method of communication be used as a model in the future when physicians must stay informed on urgent public health threats.”

Recommendations to (1) amend policy on hepatitis C and other communicable diseases; and (2) adopt new policy on physician immunization against communicable diseases (CM-ID Rep. 2). Amended new policy on Physician Immunization Against Communicable Diseases to read, “That the Texas Medical Association strongly endorses immunization of all physicians with the recommended vaccines available for preventable, communicable diseases.”

Recommendations to (1) retain policy on HIV contact tracing, (2) amend policy on HIV education programs, and (3) delete policy on HIV release or disclosure of test results (CM-ID Rep. 3). Adopted.

REFERENCE COMMITTEE ON SCIENCE AND EDUCATION

Recommendation that Resolution 101, Complaints Against Physicians With “Physician-in-Training” License from the 2009 Annual Session, not be adopted (CME Rep. 1). Adopted.

Recommendations to (1) retain. policy on community-based medical education, student loan deferment, student loan funds repayment, and instructional costs for GME; (2) delete policy on medical schools cheating, medical school curriculum required family practice rotation, medical education K-type examination, strengthening medical school education programs on universal precautions physician loan repayment, cognitive examinations, rural physician shortage pilot project, town/gown relationship, and solicitation of private patients (town/gown); and (3) to retain and amend policy on nursing schools funding (CME Rep. 2). Adopted.

Recommendation that policy on CME through hospital education be deleted (CM-CE Rep. 2). Adopted.

Recommendation that policy on patients awaiting orders of protective custody be deleted (CSA Rep. 1). Amended by retaining Policy 215.018, Patients Awaiting Orders of Protective Custody.

Recommendation to adopt and amend policy on prescription form, cigar and smokeless tobacco smoking and cancer, Texas cancer pain initiative, statewide cancer registry, and cancer unproven methods (CM-C Rep. 2). Adopted.

Resolution that TMA support development of a new allopathic medical school on the University of North Texas Health Science Center at Fort Worth campus with zero start-up dollars required from the state, while continuing to advocate for increased graduate medical education training slots (Res. 301). In lieu of resolution, reaffirmed Policies 185.005, Physician Shortage, and 200.028, Medical School Expansion.

Resolution that TMA support efforts at the state and national levels to reclassify Concerta, Vyvanse, Focalin XR, Adderall XR, and Daytrana from Schedule II to Schedule III, as these medications pose a significantly lower potential for abuse due to their time-released systems that delay rapid absorption (Res. 302). Referred.

Resolution that TMA strongly encourage the Texas Legislature to restore funding for the Statewide Preceptorship program to its pre-2003 level of $2 million to ensure the program continues to produce high-quality primary care doctors for Texas (Res. 303). Amended to read, “That the Texas Medical Association strongly encourage the Texas Legislature to provide increased funding for the Statewide Preceptorship Program through various state, federal, or other funding mechanisms.”

Resolution that TMA (1) recognize that, and shall ask the Texas Medical Board (TMB) to recognize that, the American Board of Medical Specialties (ABMS), American Osteopathic Association Bureau of Osteopathic Specialists (AOABS), and American Board of Oral Maxillofacial Surgery (ABOMS) are the standard in specialty board certification for the specialties they encompass; (2) evaluate TMB rules and practices regarding physicians’ ability to advertise that they are “board certified” in the clinical specialties of ABMS, AOABS, and ABOMS by organizations other than these three certifying bodies, and report back to the 2011 TMA House of Delegates; and (3) actively oppose all efforts of any non-ABMS, non-AOABS, and non-ABOMS certifying organizations in the State of Texas, or before the Texas Medical Board, to recognize its members as “board certified” without the equivalent certification and training standards (Res. 304). Amended to read, “That the Texas Medical Association (1) recognize that, and shall ask the Texas Medical Board (TMB) to recognize that, the American Board of Medical Specialties (ABMS), American Osteopathic Association Bureau of Osteopathic Specialists (AOABS), American Board of Oral Maxillofacial Surgery (ABOMS), and non-ABMS/AOABS/ABOMS boards with equivalent standards and training, are the standard in specialty board certification for the specialties they encompass; (2) evaluate TMB rules and practices regarding physicians’ ability to advertise that they are “board certified” and report back to the 2011 TMA House of Delegates; and (3) actively oppose all efforts of any alternate certifying organizations in the State of Texas, or before the TMB, to recognize its members as “board certified” without the equivalent certification and training standards.”

Resolution that TMA work with the Department of State Health Services on its radiology guidelines to remove pediatric core x-rays from the list of tests that NCRTs are prohibited from performing on pediatric patients (Res. 305). Referred.

REFERENCE COMMITTEE ON SOCIOECONOMICS

Recommendation to retain policy on advance directives, long-term care insurance, and infectious waste management (CHSO Rep. 1). Amended Policy 20.005 to read as follows:

20.005 Long-Term Care Insurance: The Texas Medical Association will develop an educational awareness program for physicians relevant to evolving federal laws and regulations on the benefits of long-term care insurance and the inadequacy of Medicare and Medicaid for that purpose (Substitute Committee on Aging and Long-Term Care, p 68, I-96).

Recommendations to (1) retain policy on physician extenders in rural health clinics, cost containment, hospitalists, patient education, plan responsibility, private healthcare system, impact of uninsured, laboratory personnel, managed care truth in advertising standards, Medicaid reimbursement for rehabilitation, Medicaid and Medicaid managed care, Medicare reform, medical care guidelines, and medical record review; (2) delete policy on current procedural terminology, private office labs, Medicare elective surgery, Medicare reform, health care equity, military service, Medicare billing for substitute physician services, financial responsibility for sexual assault and sexual abuse exams; and (3) amend policy on HCFA valuation and management services documentation guidelines, competitive insurance models, health insurance, individual ownership, Texas department of insurance, professional liability, managed care, managed care prompt payment, active duty physicians, and folic acid supplementation (CSE Rep. 1). Amended by substituting the word “payment” for “reimbursement” wherever the word “reimbursement” occurs in these policies.

Recommendation that TMA support changes to Medicare payment locality boundaries so that they are defined to reflect measurable differences in local economic conditions and are updated at least every five years to reflect changes in those conditions. Reliance on Metropolitan Statistical Area boundaries and updates would meet this condition. TMA supports, where necessary, revision of federal administrative rules to accommodate locality boundary changes. When locality boundaries have not been updated for more than five years and the needed changes would result in significant fee cuts for some physicians, the TMA favors locality revisions that include payment increases sufficient to assure that physicians in revised localities do not suffer fee cuts (CSE Rep. 2). Adopted.

Recommendation that TMA establish an ad-hoc multispecialty physician task force, or utilize an existing task force addressing similar issues, to devise accountable care organization (ACO) policy, policy on new payment system methodologies, and policy on possible ACO pitfalls, risks, and protections to ensure care is patient-centered (CSE Rep. 3). Adopted.

Recommendation that TMA undertake efforts including legislation to modify Texas law to establish protection from retaliation tactics for private contracting physicians and physician employees when they comply with reporting obligations and requirements to state and federal agencies (CM-PPA Rep. 1). Adopted.

Resolution that TMA (1) adopt as policy that Medicare beneficiaries be permitted to make tax-free contributions to health savings accounts; (2) urge Congress to make changes in federal laws permitting Medicare beneficiaries to make tax-free contributions to health savings accounts; and (3) that our Texas Delegation to the AMA take this resolution to the AMA House of Delegates for consideration (Res. 401). Adopted.

Resolution that TMA (1) advocate for improved funding for mental illness and substance abuse and that funding for areas of the state be proportional to the service requirements of the number served in the area, and (2) request that no psychiatric hospital beds be closed in North Texas (Res. 402). Amended to read, “That the Texas Medical Association (1) advocate for improved funding for mental illness and substance abuse treatment and that funding for areas of the state be proportional to the service requirements of the area, and (2) advocate that no psychiatric hospital beds be closed based solely on budgetary concerns in Texas.”

Resolution that TMA support an increase in the statewide reimbursement rate to physicians who provide care to patients after 5 pm on weekdays and anytime on weekends (Res. 403). Amended to read, “That the Texas Medical Association continue efforts to propose that Texas HHSC pay physicians for after hours, non-emergency care codes 99050 and 99051.”

Resolution that TMA work to ensure that prompt pay legislation already in effect include state Medicaid programs, whereby if a physician files a clean claim and the state does not pay promptly, the state is subject to paying the physician interest on the past-due claim (Res. 404). Adopted.

Resolution that TMA work to change regulations so that physicians can apply for enrollment in Medicaid HMOs without first applying to the State to be approved to participate in the Medicaid program (Res. 405). Referred with report back in 2011.

Resolution that TMA support individual Medicaid HMOs being allowed to enroll Medicaid patients directly (Res. 406). Not adopted.

Resolution that TMA do all in its power to persuade the Texas Legislature to protect and increase funding for early childhood intervention programs and mental health programs for children (Res. 407). Adopted.

Resolution that TMA support Medicaid and CHIP being on the same formulary that would change no more than annually (Res. 408). Not adopted.

Resolution that TMA study the issue and determine the best method for helping non-ordering physicians access their patients’ lab, radiology, and other test results (Res. 409). Amended to read, “That the Texas Medical Association support immediate implementation of an effective method for helping physicians who did not order patients’ lab, radiology, and other tests access those results.”

Resolution that TMA (1) oppose all public and private payer efforts to eliminate payments for inpatient and outpatient consultation service codes; and (2) support legislation to overturn the Centers for Medicare and Medicaid Services action that eliminated payments for consultation codes (Res. 410). Adopted.

Resolution that TMA (1) actively monitor and disseminate the available health care socioeconomic data from Massachusetts’ and other states’ health reform models encompassing at least three years of experience in health care reform; and (2) that, from such data, TMA make appropriate projections on how other states’ health care reform models could impact the practice of medicine in Texas and share this information with the TMA House of Delegates (Res. 411). Adopted.

Resolution that TMA, working with AMA, increase its efforts to have all rural health care clinics paid on a cost-based system without a cap, independent of type of ownership (Res. 412). Amended to read, “That the Texas Medical Association, working with AMA, increase its efforts that all rural health care clinics have payment and cap parity regardless of ownership.”

Resolution that TMA clarify that when patients who have a payer, including Calhoun County Indigent Health Care Program, are provided care, the payer is responsible for paying for services (Res. 413). Amended to read, “That the Texas Medical Association clarify that when patients who have a payer, including all county indigent health care programs, are provided care, the payer is responsible for paying for services.”

Resolution that (1) physicians who legitimately render services to Medicare patients be paid at their current practice’s geographic index without disruption, allowing for backdating the reactivation of the privilege to bill for Medicare covered services to eligible patients; (2) physicians be provided an appeals process in order to be reimbursed for care actually provided to Medicare patients when their billing privileges are deactivated for minor paperwork glitches such as failure to notify the Medicare carrier of change of office address using the proper Centers for Medicare & Medicaid Services (CMS) form; (3) access issues for Medicare beneficiaries be considered before similar CMS regulations are created; and (4) the Texas Delegation to the AMA carry a similar resolution to the AMA House of Delegates for adoption (Res. 414). Amended first and second resolves to read, “That (1) physicians who legitimately render services to Medicare patients be paid at their practice’s current geographic index without disruption, allowing for backdating the reactivation of the privilege to bill for Medicare and Medicaid covered services to eligible patients; and (2) physicians be provided due process and appeals process in order to be compensated for care actually provided to Medicare or Medicaid patients when their billing privileges are deactivated such as for failure to notify the Medicare or Medicaid carrier of change of office address using the proper Centers for Medicare & Medicaid Services (CMS) form.”