Risk Management

Working to identify and reduce potential risk exposures is an ongoing process.

Below is information on a variety of topics to assist with managing risk and remaining compliant with rules and regulations.

Advertising and the Use of Patient Testimonials

The Texas Medical Board (TMB) rules on Physician Advertising Chapter 164 include prohibitions on Misleading or Deceptive Advertising 164.3 and limitations on the use of patient testimonials, as does Advertising Records and Responsibility 164.5(c).

The Medical Practice Act Code 164.052(6) includes as a prohibited practice false, deceptive or misleading advertising.

Texas Medical Association's (TMA) whitepaper discusses Advertising Restrictions, including a special caution for testimonials.

Also, refer to the TMA whitepaper The Regulation of Physician Advertising.

The AMA Code of Medical Ethics covers Professional Self-Regulation Opinion 9.6.1 Advertising and Publicity.

Autonomy

Information and resources to assist in maintaining autonomy in clinical decision making and in a financial-business setting.

Billing and Prompt Pay Discounts

Resources to assist with billing and payers, including prompt pay discounts, recoupments and more.

Charity Care - Good Samaritan Law - Volunteer Protection Act

Texas Charitable Immunity Act - TMA whitepaper
Limiting Liability for Providing Charity Health Care - TMA whitepaper (members only)
Consent Form for Charity Care - TMA
Good Samaritan Law - TMA whitepaper - 2019 SB 752 expanded civil liberty protection to volunteer health professionals providing care during a disaster.

Compassionate Use Act - Prescribing Low THC - Cannabis (CBD Oil)

The Texas Compassionate Use Act (2015 SB 339 and 2019 HB 3703) requires the Texas Department of Public Safety (DPS) to maintain a registry of physicians who are allowed to prescribe low-THC cannabis (CBD oil) to patients with certain medical conditions.

The 2015 Act also requires DPS to maintain a list of the licensed dispensing organizations that cultivate, process and dispense low-THC cannabis to a patient for whom it is prescribed. For more from DPS.

In 2019, the Texas Legislature expanded patient eligibility for these prescriptions. 2019 HB 3703 allows certain board-certified, licensed physicians to prescribe low-THC cannabis to patients with epilepsy, a seizure disorder, multiple sclerosis, spasticity, amyotrophic lateral sclerosis, autism, terminal cancer, or an incurable neurodegenerative disease, and the physician determines the risk of the medical use of low-THC cannabis by the patient is reasonable in light of the potential benefit for the patient.

The Medical Practice Act-Texas Occupations Code, Title 3 Health Professions, Subtitle B Physicians, Chapter 169 Authority to Prescribe Low-THC Cannabis to Certain Patients for Compassionate Use explains who is authorized to prescribe and under what limited circumstances.

Before a physician may prescribe or renew a prescription for low-THC cannabis for a patient, the physician must register as the prescriber for that patient in the compassionate-use registry defined in Texas Health & Safety Code, Title 6, Subtitle C, Chapter 487 Texas Compassionate-Use Act.

2019 HB 3703 and Expansion of Texas' Compassionate Use Act - TMA whitepaper, Aug 2019
Clearing the Air on Cannabis: New Texas Laws Create Challenges for Physicians, TMA, Texas Medicine, Sept 2019
Cannabidoil Takes a Big Step Toward Respectability - TMA, Nov 29, 2018
FDA Approves Cannabidiol, But Drug Still Faces Hurdles - TMA, July 2, 2018
Oversold? Has Cannabis Oil Been Overhyped in Texas? - TMA, Texas Medicine, May 2018

Conflicts of Interest - Self Referral and Physician Ownership

The Centers for Medicare & Medicaid Services (CMS) explains Section 1877 of the Social Security Act, known as the Physician Self-Referral law and commonly referred to as the Stark Law.

The Medical Practice Act/Texas Occupations Code Sect 162.052 Notice of Certain Ownership Interests requires physicians who hold an ownership interest in certain specialized (niche) hospitals to notify the Texas Department of State Health Services, as well as to disclose the fact to the patient Sect 105.002.

Opinion 9.6.9 Physician Self-Referral - Professional Self-Regulation, AMA Code of Medical Ethics
Disclosure of Conflicts to Patients - TMA Board of Councilors Opinion
Physician ownership -TMA articles
Four Stark Law tips worth noting - TMA article

Stark: How to stay on the right side of the law - TMLT The Reporter, Volume 5 2013, beginning on page 6.

Cybersecurity and Risk Assessments

For cybersecurity guidance and resources to help protect your data and systems.

EMTALA

Information from the TMA General Counsel on EMTLA (members only).

End of Life Care

Resources from TMA on end of life care and DNR.

HIPAA and Private Health Information (PHI)

Information on HIPAA, HITECH, and the Texas Privacy Law.

Informed Consent

Informed Consent - TMA whitepaper (members only)
Informed Consent: A Process of Communication - TMA article
Conversation Counts: Improving Informed Consent Improves Patient-Centered Care - TMA article
Official Consent Forms - from the Texas Medical Disclosure Panel (TMDP) - TX Health and Human Services (HHS). Effective Jan. 1, 2020, two of the informed consent forms changed. - TMA article

Liability Protection

Articles and guidance - TMA
Professional liability insurers - TMA

Out-of-state patients - Texas physicians may wish to have patients from out-of-state sign a consent agreement that would include "choice of law and forum" language that all health care rendered shall be governed exclusively and only by Texas law and that any legal action that relates to the care shall be brought only in a Texas court. The Texas Alliance for Patient Access (TAPA) provides example consent language for emergency care and non-emergency care.
Access Preserved - New Mexico Law Allows Texas Physicians to Avoid Lawsuits Across the Border - TMA, Texas Medicine, June 2016 issue

Patient-Physician Communications and Relations

Communicating with patients who are deaf or hearing impaired or with limited-English proficiency, and interpreter and translator resources.

Patient-physician relationship for guidance and resources on establishing and terminating the relationship. 

Also, refer to other situations involving patient relations, such as treating minors and self, family, friends and employees.

Physician Extenders

Information and resources for the supervision of physician assistants and nurse practitioners.

Prescription Monitoring Program (PMP) - Pain Management - RX Drug Abuse/Diversion

TMB rules and info concerning the Prescription Monitoring Program (PMP) and the treatment and prescribing for pain.

Reporting Duties

Resources, guidance, and links to Texas statutes for reporting situations involving abuse or neglect of a child or the elderly or disabled, communicable diseases, impaired drivers, or threats of violence.

Reputation Management

Information and resources on preventing and repairing threats to your reputation and building a positive online presence.

Rules and Ethics

For Texas Medical Board and Medical Practice Act regulations and other resources, see rules and ethics information.

Subpoenas

Guidance and resources involving the proper handing of subpoenas.

Texas Medical Association (TMA) and Texas Medical Liability Trust (TMLT) Resources

Be tech savvy on the road (TMA)
Protect yourself from tax fraud (TMA)
Stop embezzlement before it starts (TMA)
Is your practice at risk...for one of these employee embezzlement schemes? (TMA)
More TMA articles and resources on risk management (TMA)

The top 5 things that get physicians sued (TMLT)
Risk management help from TMLT (TMLT)
Practice Review (TMLT)
Privacy and Security Toolkits (TMLT)