Journal of Free-Standing Medicine
Texas Medical Information Registry-ONLINE!
3/14/2014

It appears that TEXANs may have a state sponsored on-line medical registry in the works. This registry would allow patients to control their medical records and easily grant their treating physicians access to their records. The registry will be stored on-line and may include a full history and latest physical results along with all lab, testing, procedural information and admission records. This record can be updated constantly to reflect the most up to date information regarding the patient's history. The registry will be accessible via any internet connection. The entire process will be secure and HIPPA compliant.

Imagine how much easier it will be for physicians to obtain the records needed to practice high quality, informed medicine. Consider how seamlessly patients may share this information with their treating physicians.

This rough draft was given to the JFSEM by a member of the Texas State Silver Haired Legislature who drafted it in the hopes that they may receive feedback from healthcare workers prior to attempting to turn this into law. Take this unique opportunity to read the rough draft of the bill that promises to develop the Texan Medical Registry and leave your comments. Below is the rough draft of the proposed legislation :

Enabling Patients in Texas to Access Their Own Medical Records from an Authorized Registry and to Make Those Records Available to Others

To allow medical patients in the state of Texas to readily archive and access their own medical records and to provide means for them to securely provide selected records to their other medical care providers, the following provisions are hereby enacted:

Part I. Registry Medical Records

A patient in Texas (or that patient’s duly authorized surrogate) shall be entitled to have a copy of any medical record that is developed for and applies to that patient. The practitioner or medical facility shall charge patients no more than the actual cost of copying or transmitting those records in digital form.

The HHSC is hereby authorized to establish or authorize one or more Medical Records Registries in Texas to accommodate the storage and retrieval of patients’ medical records, in accord with the following:

Authorized Registries shall be located in Texas, be subject to Texas laws, and shall restrict access to those records. A Registry’s security precautions shall be equivalent to the high level of security precautions commonly adopted by Texas banks for the protection of their on-line banking customers.

Registry medical records shall be accorded privacy rights and protection at a level no less than the privacy and protection accorded under Texas laws to doctor/patient information and attorney/client information, with comparable enforcement and penalties established for violations of the privacy and protections. Access to a Registry shall be permitted ONLY for the following:

(a) Individuals, to access their own medical files or to add medical records (including lab reports) to their Registry files, and

(b) Medical practitioners and their medical support staff, to access specified records of a current patient, but only with the prior consent of that patient (or surrogate) in writing, and

(c) Medical practitioners or other appropriate staff of a medical facility to enter a current patient’s medical records and lab reports into his or her Registry files, but only with the prior consent or request of that patient (or surrogate).

Upon request by a patient or that patient’s surrogate, a medical practitioner or the staff of a medical facility originating medical records for that patient shall provide a digital copy of those records to the patient, or with the consent of the patient, record them in that patient’s Registry files. Prior to delivering records to a patient or entering them in a Registry, a practitioner or medical facility shall insure the patient is informed in writing of the importance of safeguarding medical records.

A practitioner or medical facility that maintains an internal record file for a patient may, with the written consent of that patient, add to their internal files that patient’s medical records from the Registry.

Part II Standardized Registry Forms for Patients’ Basic Information

Patients are typically required by each practitioner and medical facility to complete forms containing basic information about the patient. The style and format of the forms may vary, but the content is essentially the same. In order to avoid patients repeatedly and needlessly filling out so many forms that require the same information, an authorized Registry shall, at the request of any person, maintain a Patient’s Standard Information form for that person. The standard form shall be designed by the HHSC after consulting with interested persons and organizations. With a patient’s consent or request, health practitioners and health facilities shall retrieve that patient’s standard information form from the Registry for their internal use. Any appropriate corrections or changes authorized by the patient may then be made to the Registry’s master copy of the form.

Part III HIPPA Violations:

Notwithstanding any other provision of Texas law to the contrary,

(1) the act of medical practitioners or staff members of a medical facility in providing a patient’s medical records to the patient or to an authorized Registry (with the consent of the patient or the patient’s duly authorized guardian or surrogate) shall not be deemed, construed or in any way interpreted to be a violation of HIPPA provisions or a violation of any other rights of the patient under any Texas law or by any Texas Court, and

(2) in the event the copies of the patient’s records transferred to the control and protection of the patient or the Registry are subsequently accessed or disclosed improperly, the above grant of immunity from HIPPA violations shall remain in effect for those who provided the records to the patient or to the Registry.

Free Standing ERs vs Colorado Legislature: Keeping Personal Choice in the Equation
3/19/2014

By Kate Walker

Keywords: Colorado Senate bill 16, Freestanding ER, Senator Irene Aguilar

America has a consumer attitude with which we approach life. There is no question, as a culture, we like choice. We like to have options so we can choose the types of food we eat, the clothes we wear, and the places we live. Choice is a major part of the American way of life. So tell me, why doesn’t this apply to all aspects of our health care system? Yes, we have some choices when it comes to who our general practice physician is or what insurance we have but we should also be able to have options when it comes to our emergency health care. Is it normal to have a choice when a person needs immediate medical attention? No, they go to the nearest hospital emergency room and hope they won’t be waiting for hours to see a doctor.

To give such a choice, an emergency care model was established and put into practice. Unfortunately, there is legislation brewing in Colorado that would put an end to the entire idea. Now, both sides of the issue are lining up to duke it out and it is looking to be one hell of a prize fight.

Let’s set the stage for this confrontation. Free Standing ER’s are locations that are open 24/7 that offer the public access to urgent or emergency health care. Now, don’t go thinking that they are Podunk ERs that practice hillbilly medicine; these are fully equipped, fully staffed, and certified Emergency Rooms where a person can receive a high standard of medical care.

Do you have questions about this emergency care model? Take the word of the Urgent Care Association of America on the subject: http://www.ucaoa.org/docs/Article_Freestanding.pdf

So what’s the problem?

If Free Standing ERs are allowed to exist, it breaks the health care monopoly of the hospitals. Period. In the past, hospitals could charge whatever they pleased for whatever services they provided because they had no competition! Now, with a change in the “health market”, they are doing everything they can to keep the monopoly in place and the big bucks rolling in.

The insurance community is also weighing into this fight because they believe they will lose money. Imagine an insurance company being greedy and keeping money in their coffers, it shouldn’t be too hard but I digress from the topic at hand. Let’s get back to the prizefight.

Enter the ring, politics and legislation: Senate Bill 16. Being sponsored by state Senator Irene Aguilar, the bill forces more restrictions on Free Standing ERs that would essentially put them out of business. How? By making them play by different rules, of course! All ERs that are connected to hospitals charge a “facilities fee” that allows for the doors to stay open 24/7 in order to provide services. This bill forbids Free Standing ERs to charge the same fee. This is the same as putting two boxers in the ring but not allowing one to use his fists.

This country was built on competition; it is high time that the emergency health care system received a dose of it. Don’t take my word for it, look it up: Free Market Principles. Expect to be reading for a few years.

Let’s examine some facts, shall we? Free Standing ERs do not have the overcrowding issue that hospitals have. They do not have the wait times. The CDC states that urban ERs have a mean wait time of over an hour; the larger the hospital, the longer the wait time. This means that smaller ER facilities akin to Free Standing ERs have shorter wait times due to the lesser patient volume. Think this is incorrect? Check out this graph that the CDC released.

1Trend by annual emergency department visit volume is statistically significant.
2Mean wait time in emergency departments with fewer than 20,000 annual visits is significantly lower than wait times in emergency departments in other volume categories.
SOURCE: CDC/NCHS, National Hospital Ambulatory Medical Care Survey.

Figure found at: http://www.cdc.gov/nchs/data/databriefs/db102.htm

Time is a major factor in emergency situations. Ever heard of the Golden Hour? Go look it up if you haven’t. My point is that if I or someone I love is in crisis, I don’t want to sit in an ER waiting room for an hour before receiving medical care.

Back to the prizefight at hand: hospitals are fighting tooth and nail to change the mode of emergency health care. Want to know something crazy? There is already precedence for Free Standing ERs in the United States! And, interestingly, it didn’t make the whole system come crumbling down. In fact, it works quite well; the system is Ambulatory Surgical Centers (ASC).

ASCs are outpatient clinics that allow for simple or non-invasive procedures to be done; taking pressure off the major hospitals in the area. The American Academy of Orthopaedic Surgeons (AAOS) boasts how ASCs have numerous benefits for patients through “…more convenient locations, shorter wait times, and easier scheduling”, less interruptions due to emergency cases, and the physicians choose their staff allowing for increased efficiency. The growing number of ASC’s in the United States is being called “A positive trend in Health Care” and is actually embraced by the medical community.

Want to see how much the AAOS approves of and supports ASCs? Go to their Ambulatory Surgical Centers Position Statement here: http://www.aaos.org/about/papers/position/1161.asp

So why are Free Standing ER’s getting so much condemnation for trying to do the same thing?? That’s easy to answer: Money. The groups that are fighting this change are the insurance companies and the hospitals that are losing money because patients are getting better health care.

So, who am I and why am I talking about this? I’m glad you asked.

I’m a grad student that is working my butt off in order to make a future for me and mine. I travel when I can and love to see how people live. I believe in basic human rights such as self-determination and good health. I believe these values are necessary for the world; imagine how much more I believe in them for my country, my state, my town, and my people. This legislation in Colorado would leave me with no choices if I ever needed immediate medical care. In fact, it takes choice completely out of the equation.

By all means, let the emergency system herd and pack in patients like they are sheep after making them wait obscene amounts of time.

Or we can allow for more choices, more competition, and potentially increase the quality of the health care system in the United States.

While I may be the girl next door, I have a brain and I know how to use it. In this situation, the choice is obvious: I side with the Free Standing ERs. I believe in their right to exist and to challenge the standard operating procedure that has been left unopposed for far too long.

ER Docs are finally allowed to see how much money is being collected for their services!
4/7/2014

April 2, 2014

AAEM Member Center |

AAEM Update: Access to CMS Payments

In 2013, AAEM sent a letter to CMS (see below) urging the opening of physician payment information upon a Freedom of Information Act (FOIA) request. While this proposal was directed at patient access we know that many EM physicians are denied access to what is billed and paid in their name and could also benefit from this knowledge. CMS has now announced that you can get access to physician payment information. The details are listed in the Federal Register at: http://www.gpo.gov/fdsys/pkg/FR-2014-01-17/pdf/2014-00808.pdf.

EM physicians are encouraged to send a FOIA request for what has been paid in their name to the below address. The following link will take you directly to everything you need to do this including a sample FOIA letter with the address on where to send it. We have also provided a phone number if you wish to inquire further.

Website: http://www.cms.gov/foia/.
FOIA Requester Service Center: Phone: (410) 786-5353

Send request to:
Michael Marquis
FOIA Officer
North Building, Room N2-20-06
7500 Security Boulevard
Baltimore, MD 21244
(410) 786-5353 (Telephone)
(410) 786-0474 (Fax)

See the public comments on this matter including AAEM’s (PDF)

View resources on the AAEM website

What Uncle Sam Paid the Doc
4/13/2014

If you are a doctor and are interested in seeing how much Uncle Sam reimbursed you for your work in 2012

Click on this link to find out

It appears that Uncle Sam is not paying Free-Standing ER docs very much... This makes sense since CMS has not yet begun recognizing Free-Standing ERs as facilities unless ofcourse they are owned by hospitals. So not only are individually owned Free-Standing ERs greatly increasing the access to high quality care but they are also lowering the cost of care especially to programs like medicaid and medicare.

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