AD DIRECTORY
ATIMAP Telemedicine Medical Weight Loss Group ................................................49
Capital Farm Credit ..................................... 41 Children’s Connections Inc. ........................56 Dept. of State Health Services ..............12, 32 EmCare ........................................................56 Houston Methodist Hospital .........................5 Humana ....................................................... 13 Leichter Law................................................43 Lexicon Medical ..........................................55 REC–Gulf Coast ..........................................37 Texas Health Services Authority .................32 Texas Health Steps .......................................6 Texas Medical Association Bank of America........................................38 Be Wise — Immunize ................................45 Future Meetings ........................................52 Hard Hats for Little Heads ........................46 Membership ..............................................55 Minority Scholarship Program .................46 Online HIPAA Security Manager ...............49 Practice Consulting ....................................3 Practice Management Education ...... 14, IBC TEXPAC .....................................................38
Texas Medical Association Insurance Trust ....................................................... BC
Texas Medical Liability Trust ......................IFC TransFirst .................................................... 10 West, Webb, Allbritton and Gentry, PC .......45
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provide efficient and adequate over- sight to the practice of medicine.” The position statement emphasized that to improve patient care while using EHRs, the necessary data elements in the record need to be properly identi- fied, recorded, verified, and tagged. “In recent years, TMB has observed
progressive difficulty obtaining medi- cal decisionmaking information from current records, which interferes with the accomplishment of our mission,” the position paper states. “It is not the role of the TMB to endorse EMR soft- ware or regulate technology. However, it is clearly within the TMB’s scope and oversight duties to set forth stan- dards and expectations for creating and maintaining a useful, meaningful and readable medical record.” The medical board’s disciplinary
rules establish low- and high-sanc- tion guidelines for violations of the Medical Practice Act or TMB rules. A remedial plan for failure to keep proper medical records carries a fine of $500 on the low end, along with continuing medical education (CME) in the “appropriate area,” such as medical recordkeeping. On the high end of the guidelines, an order can include a $2,000 administrative pen- alty. For example, in November 2014, the board issued $2,000 penalties to two physicians. One physician failed to document the rationale for the care of a patient, according to a TMB news release. The other physician inad- equately documented conversations with a patient pertaining to the ra- tionale for surgery. If a physician has been issued a prior order by TMB for inadequate recordkeeping, he or she may be required to take a Physician Assessment and Clinical Education course in recordkeeping. The board issues administrative penalties at its discretion, however, and can go north of the $2,000 pen- alty. For example, last April, the board issued a $3,000 penalty to a physician who admitted failing to adequately document medical records for ap- proximately 11 visits and to “making
58 TEXAS MEDICINE July 2015
late entries without indicating the amendments were not made contem- poraneously with original notations,” TMB said in a news release. Ms. Robinson says the board’s en-
forcement activity is complaint-based in the majority of cases. It only has the authority to initiate inspections without a complaint in cases involv- ing office-based anesthesia and pain management. TMB can file a com- plaint, Ms. Robinson says, “but that generally only happens when we re- ceive information through our offices another way,” such as if the board per- forms a CME audit and finds a physi- cian doesn’t have the proper credits or if a physician has been found guilty of a crime. Depending on the final resolu-
tion of a case, the board may also be required to report a violation to the federal National Practitioner Data Bank, which has its own guidelines about what certain entities need to re- port (see
www.npdb.hrsa.gov/hcorg/ aboutReporting.jsp). “So it could be that there was a small
error, and the board feels that the ap- propriate resolution is a remedial plan, which is a nondisciplinary order that is not reportable to the National Prac- titioner Data Bank,” Ms. Robinson said. “However, there could be a re- ally, really large and egregious set and pattern of violations. So depending on the penalty there, if a disciplinary action is taken, it is absolutely report- able to the National Practitioner Data Bank. So anything connected with the practice of medicine that’s a disciplin- ary action in the vast majority of cases is federally mandated to be reported.” Ms. Robinson says TMB does not
keep statistics on how many remedial plans it issues for medical record vio- lations. For more information on re- medial plans and TMB’s enforcement process, visit
www.tmb.state.tx.us/ page/enforcement. n
Joey Berlin is a reporter for Texas Medicine. You can reach him by phone at (800) 880-1300, ext. 1393, or (512) 370-1393; by fax at (512) 370-1629; or by email at
joey.berlin@
texmed.org.
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