Letter from your President



I hope that all of you had a wonderful summer and that you came back with recharged batteries, full of energy and ready for action in your county medical society.

On the state level we are over 50,000 members strong. This is very powerful force that made significant impact on medicine related issues during this year’s legislative session. Our Lubbock County Medical Society (LCMS) members played an important and visible role in these activities. This past weekend during the 2017 TMA Fall Conference in Austin, a number of our members sat on and participated in the proceedings on many Councils, Committees, Boards, Ad Hoc Committees, Sections and other meetings. We were visible, noted, highly appreciated and respected for our contributions.

 Currently, our county medical society has 1,536 members (an all-time high). Our Medical Society is only as good as our memberships’ involvement. I am challenging every one of our members to become active participant and get involved in what-ever capacity in the works of our County Medical Society, Texas Medical Association and American Medical Association. My goal is to increase to 1,200 (80%) the number of our Medical Society members actively involved and engaged in works of medical society activities at local, state and national levels. A lofty goal!  The just released 2017 – 2018 LCMS Membership Directory lists all our county medical society (CMS) committees, boards as well as current active members of these committees. I am inviting you to become a volunteer on one or more of these committees, if you are not already doing so. This summer, we renovated and enlarged LCMS meeting center so that we can accommodate larger numbers of attendees. Talk to current committee members and call medical society office staff to see where you can join. On our web-site we will list TMA Committees, Councils and work groups and names of current LCMS members sitting on them. You can discuss with our LCMS staff opportunities to join these committees. I am a member of TMA Committee on Cancer but I attend as a guest many other group meetings and I have been learning a lot from them. TMA’s work groups are powerhouses of information, knowledge and activities. This reminds me to tell you to look at our new, fresh webs site address (www.lubbockcms.org) that has been developed by joint efforts of our Community Relations Committee and the TMA staff. Also, become accustomed to routinely access the TMA web site (www.texmed.org) that is a treasure house of valuable information, a great place where to acquire knowledge, CMEs, press releases etc. Visit TMA in Austin, but coordinate it with our LCMS office staff before you embark there. Of course, if you are on any TMA working group you will have a chance to visit the TMA organization on a routine basis. During this year’s TMA’s Legislative First Tuesday’s visits with our legislators, TMA was a gathering place, training and coordinating center prior to visiting the Capitol. I am very impressed with our TMA organization and staff and I am convinced that they are not second to any state medical society.

Here are some TMA future events:

1.      December 1 and 2 there will be TMA/Texpac Legislative Retreat in Austin for TMA members. If you want to attend call our LCMS office for more information.

2.      January 26-27 there will be 2018 TMA Winter Conference in Austin. Attending conference is free for our members. For more information call LCMS office or go to TMA website.

3.      May 18-19 there will be TexMed 2018, TMA’s Annual Meeting, Premier Educational Showcase, and EXPO in San Antonio at the JW Marriott San Antonio Hill Country Resort. Highly recommended event beside on side you may enjoy San Antonio attractions. Again, attending the meeting is free of charge to our members, and cost of travel and lodging is tax deductible as cost of your professional development and education. TMA is issuing CME credits for educational sessions attended. For more information call LCMS office or go to www.texmed.org/Events.

Here are some home agenda items for your actions:

1.      LCMS is soliciting your nominations of our LCMS members for consideration for 2017 Hippocratic Award. Candidates should be members of LCMS/TMA for at least 20 or more years and he/she served the community with outstanding and exemplary distinction. Please, in your nomination form describe briefly the reason for this member to be considered for this honor. We realize we have many such worthy candidates. Hippocratic Award Committee will review all submissions and select 5 candidates for our LCMS membership to vote on. Deadline for nomination submission is the end of this (September) month. The Hippocratic Award will be given out at our Annual Meeting (December 14).

2.      We are seeking suggestions from our members for the Friend of Medicine Award to be given out at our Annual Meeting. Candidates are individuals, groups or organization that have supported and helped the medical establishment in our area. Committee will select award recipient to be handed out at our annual meeting.

3.      We are seeking nominations for the school Science Teacher Awards. Candidate should be a school science teacher, teaching and promoting science in unique and stimulating fashion inspiring students to go into science related fields, including medicine. Call CMS office for details. This award is given out by TMA.

4.      As a part of the 2017 Year of Physicians, I am soliciting names of our LCMS members that published books, poetry, art pieces, recorded CDs etc. We would like to establish a collection and exhibit of our creative members’ works to be exhibited at our annual meeting and in our county medical society office.

The Lubbock County Medical Society Annual Meeting and Dinner will be held on December 14 at the Merkett Center on TTU campus. Please, plan to come for an evening of camaraderie, fellowship, friendship and fun. Help our society grow and become more influential on the state level. Let TEAM LUBBOCK shine! We are on the move!


 Davor Vugrin, MD, FACP

President, Lubbock County Medical Society



Alert! Electronic Death Registration Required

Starting Aug. 31, physicians must submit all cause-of-death information and medical certifications to the Texas Department of State Health Services (DSHS) electronically through the state's new online death registration system, the Texas Electronic Registrar (TER).

DSHS Commissioner David Lakey, MD, said in a letter to physicians that the new system, required by state law, "allows physicians to quickly complete cause-of-death information and death certification via the Internet. As a former practicing physician, I appreciate this convenience."

Dr. Lakey says TER allows physicians to certify cause of death any time from any location with Internet access. It also "allows physicians to delegate completion of the death certificate to office staff, while still requiring the physician to enter a personal identification number to complete the actual electronic certification. This system is available at no charge to you."

In addition, he says, the speed of the electronic death registration will give medical researchers valuable mortality data faster than previously possible. "Based on cause-of-death data, public health resources can be best directed towards prevention and education. Ultimately, use of TER will benefit the health of all Texans," he said.


Blue Cross Ratings 'Deceptive and Invalid'


Blue Cross and Blue Shield of Texas' BlueChoice Solutions (BCS) physician-rating system does not use an accurate or independently validated method to determine a physician's risk-adjusted cost. That, combined with other problems with the program, "renders the method deceptive and invalid for credentialing and related performance assessment purposes at both individual and group physician performance levels as well," a Texas Medical Association ad hoc committee concluded.

Chaired by San Antonio emergency physician Robert W. Kottman, MD, the Ad Hoc Committee on BlueChoice Solutions/Risk Adjusted Cost Index (RACI) conducted a detailed examination of BCS. The committee looked at issues such as clinical attribution, accurate comparisons to peers, and expense of admitting/treating facilities.

The committee's report [PDF] to the TMA Board of Trustees and Council on Socioeconomics made four observations and recommendations:

The current method for "actual cost" assignment BCS uses to determine a physician's RACI is seriously flawed, is not scientifically validated, and should not be used as a relative measure of "affordability." Costs are inaccurately and/or unfairly attributed to physicians caring for BCS patients. "Examples would be imaging and/or lab tests ordered by other physicians, or a patient's decision to pursue an emergency department visit in lieu of scheduling a physician office/medical home visit. When more than one physician is involved in the care of a complicated patient with multiple co-morbidities, it often becomes virtually impossible to appropriately assign the costs of care to a single physician. The BCS RACI, however, does exactly that."

Blue Cross should immediately address and resolve claims coding and processing system problems. There is a serious question about Blue Cross's capacity to receive electronic or paper submissions with all of the coding information necessary to fairly and completely process BCS claims. The issue deserves Blue Cross's prompt attention since an important root cause of the problems with the BCS claims database is inaccurate and/or incomplete data generated from the Blue Cross claims coding and processing systems. These capacity concerns threaten the integrity of transactions in the network and the viability of the network itself.

Important information related to covered BCS benefits and related patient service costs outside physician offices is generally not available nor disclosed to participating and/or billing physicians. All relevant cost of service attribution and covered benefit information affecting BCS network physicians' service and referral decisions for patients/enrollees should be fully transparent, available, and disclosed to physicians and patients in all applicable, covered settings of care. Blue Cross should "substantially improve and make transparent all due process options…"

Clear and unambiguous information that describes the process for appealing their rankings is not easily available to physicians, their offices, and patients. In addition, the company's local provider service representatives sometimes give BCS physicians or their staff conflicting, incomplete, or inaccurate information about how to appeal, and the distinctions between requesting disputed data on RACI scores and actually filing a formal appeal. Blue Cross should substantially improve and make transparent all due process options under the Health Care Quality Improvement Act.

"I think the report speaks for itself, and I wanted to let you know that TMA fully stands behind and supports the recommendations in the report," TMA President Josie R. Williams, MD, said in a letter forwarding the report to Blue Cross Chief Executive Officer Darren Rodgers.

"The report is well conceived and researched, and also reflects the many reports we've received from our members about their experience with the BlueChoice Solutions risk adjusted cost index. As the report notes, it is our strong conclusion that the RACI methodology is sufficiently flawed to render it invalid for use in credentialing and recredentialing BlueChoice Solutions network physicians," she wrote.

"We sincerely hope Blue Cross Blue Shield of Texas will review the findings, and take appropriate action to discontinue the use of the BlueChoice Solutions RACI in that plan's network credentialing."

Physicians who don't agree with the rating Blue Cross gives them can log on to the TMA Web site for an explanation of the rating system, an easy way to log your complaint, and information on what you can do if you don't like your rating.