Texas: Creating the Nation’s Model Prescription Monitoring Program

The Texas Orthopaedic Association (TOA) is urging members to write to their state lawmaker to ensure that the Texas Legislature provides funds for the Texas State Board of Pharmacy (TSBP) to acquire the NarxCare license for Texas physicians to meet the state’s September 1, 2019 mandate to check the prescription monitoring program (PMP) database. Below is a widget to contact your state lawmaker. Due to the mandate’s upcoming deadline, it is critical for the Legislature to secure funding in the supplemental package.

The state’s PMP collects a patient’s controlled substances prescription drug history, which allows pharmacists and physicians to review a patient’s prescription drug history. This mandate served as the centerpiece of the 2017 Legislature’s effort to address “doctor shopping.”

Orthopaedic surgeons view the PMP as a helpful clinical tool that could limit some misuse and diversion. However, the PMP, in its current state, requires physicians to manually log into the program, which takes valuable time away from patient care. Fortunately, Texas has the ability to follow the lead of many other states by purchasing the NarxCare license for all physicians to whom the mandate applies (Texas State Board of Pharmacy for Statewide Integration Purchase & Enterprise NarxCare & Clinical Alerts). This technology adds a tool to a physician’s electronic health record program that allows a physician to simply click a button in the patient’s electronic file that seamlessly directs the patient’s file to a view of the patient’s PMP history, which satisfies the mandate.

The Texas Legislature is likely to continue the discussion about opioids again in 2019. TOA strongly urge members to read the Texas Orthopaedic Association’s white paper on the issue, which provides helpful background on opioids. Click here to view the paper.

When policymakers make policy decisions related to opioids, care must be taken to limit unintended and undesirable consequences. Unfortunately, the current nationwide shortage of parenteral (intravenous) opioids can be traced to past responses to the opioid crisis. It is important to keep in mind that high-energy injuries, such as pelvic and femur fractures, and certain musculoskeletal surgeries, such as spinal fusion for adolescent scoliosis, create tremendous pain that may require an opioid response. It is critical to not enact policies that would have the unintended consequence of preventing patients who have suffered high-energy injuries or who are undergoing major surgeries from having access to adequate pain control mechanisms. With that said, the Texas Orthopaedic Association (TOA) recognizes that opioids are part of our nation’s overall drug misuse and abuse epidemic, and it is critical for orthopaedic surgeons to identify ways for physicians to be a part of the strategy to decrease opioid use, misuse, and abuse.

Per the American Academy of Orthopaedic Surgeons (AAOS):

The AAOS believes that a comprehensive opioid program is necessary to decrease opioid use, misuse, and abuse in the United States. New, effective education programs for physicians, caregivers, and patients; improvements in physician monitoring of opioid prescription use; increased research funding for effective alternative pain management and coping strategies; and support for more effective opioid abuse treatment programs are needed.

Click here to read the TOA White paper on this issue.



Respond to Texas Legislature’s Proposal to Limit Prescriptions to Seven Days

State lawmakers have proposed legislation (HB 2174 and SB 1233) that would:

  • Limit Schedule II prescriptions to seven days with no refills.
  • Require physicians to complete two hours of CME training in pain management every year.
  • Mandate electronic prescribing for every Schedule II prescription beginning in 2021.

TOA has made it easy for you to e-mail your state lawmakers about the proposal and express your concern.

In addition to sending an e-mail, consider sending additional messages to your state lawmakers through the following avenues:

  • Social media. Twitter is typically the best way to reach a lawmaker – they constantly check it. You can also send message to your lawmakers on their Facebook pages.
  • Phone calls. Call their Austin office and talk to the chief of staff about the issue.

Key Notes

HB 2174 and SB 1233 have been proposed by State Rep. John Zerwas, MD (R-Richmond) of the Houston area and Sen. Lois Kolkhorst (R-Brenham). The legislation is being pushed by the state’s attorney general, Ken Paxton.

Seven-Day Limit

The attorney general has argued that over 30 states have put measures in place that limit Schedule II prescriptions to seven days.

Feel free to your own words as to why this is not a good idea for certain musculoskeletal surgeries and injuries in your e-mail to your lawmakers. (We created a suggested message for you in the e-mail.)

Electronic Prescribing

Congress passed an opioid law last fall that requires Medicare to implement electronic prescribing for Schedule II drugs beginning in 2021. The Texas Legislature’s bills mirror Medicare’s 2021 date. However, it is important for the Texas mandate to take into account any delays from Medicare with its own implementation.

Two Hours of CME in Prescribing Controlled Substances

The legislation would mandate two hours of CME related to prescribing controlled substances every year.


Read our one-pager on the issue. 



Ask Your State Lawmakers to Support the Good Commercial Insurance Bills

State lawmakers have filed a number of bills in the Texas Legislature that would make it easier for orthopaedic surgeons to deliver care to Texans. The bills related to commercial insurance would:

  • Eliminate unnecessary hassles related to prior authorization.
  • Stop health plans from dropping physicians from networks if they refer to out-of-network facilities or physicians.
  • Require health plans to update their network directories on a regular basis.

Orthopaedic surgeons and their staff members are strongly encouraged to ask their state senators and representatives to co-sponsor these bills. We made it easy for you: Click on the link at the bottom to send e-mails to your state lawmakers.  If you wish to edit the e-mail or add your own personal message, you can do so.

In addition to sending an e-mail, consider calling your lawmakers’ Austin offices and sending messages via social media (Twitter and Facebook).

Click here to read a one-pager about the issue



Texas Lawmakers Considering a Prescription Drug Mandate

The Texas Senate passed a bill (SB 316) on April 12 that creates a mandate for physicians to check the state’s prescription drug monitoring database (PDMP) before every Schedule II controlled substance is prescribed, beginning on September 1, 2018.  The purpose is to stop “doctor shoppers.”

SB 316 contains several exemptions from the mandate:

  • Cancer/hospice care.
  • An exemption for any drug that is a supply of 72 hours or less was offered by the bill’s sponsor.
  • Veterinarians are exempt.

“Doctor shoppers” do not undergo surgeries to acquire drugs.  Yet surgeries were not included as an exemption in SB 316.

It is critical for orthopaedic surgeons to contact their state representatives and senators to create an exemption for surgery in SB 316.

Feel free to edit the proposed message to put it in your own terms.

Click here to view Senator Buckingham’s potential amendment.

Click here to read a one-pager on the issue.


Help Ensure That Patients Have Access to Physicians in the Designated Doctor Program

Texas’ Designated Doctor program has witnessed a decrease in the number of physicians who are participating in the program. According to an open records request of Designated Doctor data, physician participation in the program decreased by 67 percent from January 1, 2011 (1,361 physician) to January 1, 2016 (447 physicians).

The goal of the Designated Doctor program is to provide an optimal examination to an injured worker to ensure the best possible outcome. However, an optimal examination may not be possible without a broad representation of physician specialties available to the injured worker. For some injuries, such as a complex musculoskeletal injury, it is critical for the injured worker to have access to the Designated Doctor who has the highest level of training. And that Designated Doctor is likely to be an orthopaedic surgeon, who has completed four years of medical school, a five-year residency in orthopaedics, and at least one fellowship in a sub-specialty field.

The Texas Department of Insurance – Division of Workers’ Compensation (TDI-DWC) has the ability to attract more physicians to the Designated Doctor program through the changes in the regulatory process. You are strongly encouraged to contact your state representative and senator to ask them to sign a letter to Ryan Brannan, the Workers’ Comp commissioner, to ask him to make changes to the Designated Doctor program.

You are encouraged to click on the link below to send an e-mail to your state representative and senator to ask them to sign the letter. Please contact Bobby Hillert, the Texas Orthopaedic Association’s executive director, with any questions. He can be reached via e-mail at Bobby@toa.org or via mobile phone at 214.728.7672.

The goal is to send the letter to Commissioner Brannan by June 30.


Click here to read example letter

Click here for a factsheet on the issue



Maryland Surgeons Contact Your Legislator: Help Us Oppose Bill Allowing Podiatrists to Use the Title Physician


The Maryland Orthopaedic Association (MOA), representing 236 surgeons, is asking our members to write in opposition to HB 1430 in Maryland. Please scroll down to take action and contact your legislator. This bill allows podiatrists to use the title “physician.” The AAOS and MOA oppose the use of the title “physician” by non-physician clinicians as it is likely to confuse the public by implying that the clinician is engaged in the unlimited practice of medicine.

Podiatrists and orthopaedic surgeons are trained differently. The lower extremity is one of the more complex areas of the human musculoskeletal system, and an orthopaedic surgeon will attend four years of medical school, serve a five year orthopaedic surgery residency, and typically take an additional year of subspecialty fellowship training. MDs or DOs participate in active clinical care in multi system trauma and disease management, which is not the case for all podiatrists, and is a prerequisite for peer-review oversight.

While recent changes have improved podiatric education, it is not the same as the multi-system medical education required to become a MD or DO, nor is it the same accreditation process. They do not participate in the United States Medical Licensing Examination, which is the standard for all advanced medical care and essential to the degree of MD and DO. We believe that the title of physician should be attained through the accreditation process, and not the legislative process.


Help Oppose SB 728 and HB 2118: PT Direct Access for 30 Days Without a Diagnosis

State Senator Van Taylor (R-Plano) and State Rep. Stephanie Klick (R-North Richland Hills) introduced SB 728 and HB 2118, which would give physical therapists 30 days of direct access to a patient without an appropriate referral. The Texas Orthopaedic Association, Texas Medical Association, Texas Academy of Family Physicians, and Texas Pediatric Society are among the medical groups that oppose SB 728 and HB 2118.

Physicians are strongly encouraged to contact their state representatives and senators and ask them to oppose SB 728 and HB 2118. TOA has prepared a form e-mail that you can send to your lawmakers. However, we strongly encourage you to delete the text and put the message in your own words to make the message stand out. State lawmakers receive numerous form e-mails each day. They are more likely to pay attention to a personally crafted e-mail.


Click here to read the response from Texas medical specialty societies.

Click here to read the one-pager that was shared with lawmakers.

Click here to read the message about differential diagnosis for lawmakers.



Texas: Don’t Support HB 29 and SB 732, There Is a Better Solution for Physical Therapy Direct Access

Bills have been filed in the Texas House (HB 29) and the Texas Senate (SB 732) that would give physical therapists 30 days of direct access to patients without an appropriate referral. TOA members are asked to reach out to their state representatives and senators to ask them to not support these bills.

You can send e-mails to your state lawmakers through the grassroots e-mail program that can be found below.

While physical therapists are important members of the health care team, they are neither licensed nor trained to make a medical diagnosis. A medical diagnosis serves as the foundation for physical therapy services and acts as a filter to ensure that a patient is provided the most efficient and high-quality treatment possible. In addition, it can rule out more serious medical conditions.

TOA has presented alternative language for the bill’s sponsor to consider. For a person over five years old with a specific injury or condition to see a physical therapist for a one-time instruction of a home exercise program without first obtaining a medical diagnosis and a proper screening would be reasonable. Any treatment beyond that, however, should be guided by a medical diagnosis from a physician.

TOA firmly believes that the best course for an individual who is suffering from discomfort is to first see a physician in order to obtain a medical diagnosis before embarking on any treatment regimen.



Texas Legislature Must Update Spinal Screening Standards in Schools to Match Current Science

Major new research has found that bracing may deter the need for surgery when scoliosis is found at an early age. Unfortunately, Texas’ school screening standards are set by legislative statute, and the current ages may be too late for early detection to be made.

Contact state representative and senator to ask them to co-sponsor HB 1076 and SB 850 to update the state’s screening standards.  The bills would grant the Department of State Health Services the authority to update the state’s screening standards based on recommendations made by the American Academy of Orthopedic Surgeons, American Academy of Pediatrics, Scoliosis Research Society, and Pediatric Orthopaedic Society of North America.

We have provided sample text for your e-mail. However, please feel free to put your message in your own words.  Lawmakers are far more likely to respond to a personalized e-mail than a form e-mail.

The bill is supported by the Texas School Nurses Organization, Texas Pediatric Society, Texas Orthopaedic Association, and Texas Medical Association.


Issue Background: New Research Confirms That Bracing Due to Early Detection Can Avoid Painful Surgery

Scoliosis is an abnormal curvature of the spine, and it has no known cause (idiopathic).  The medical community has learned much over the past few years regarding the importance of early detection.

A major Level 1 NIH-funded study published in a September 2013 edition of the New England Journal of Medicine provided the most compelling evidence to date regarding the importance of early detection and the efficacy of brace treatment in adolescent idiopathic scoliosis.  It showed that bracing significantly decreases the progression of high-risk curves to the threshold of surgery, and that the benefits of bracing increases with longer hours of brace wear.  [Weinstein, et al, NEJM-2013]

Researchers at Texas Scottish Rite Hospital in Dallas recently conducted two award-winning studies that show brace treatment is effective in preventing the need for surgery, and that patients who use a monitor to document brace-wear patterns, and who are counseled accordingly, are significantly more likely to be successfully treated. [Brace Treatment Controls Progression in Adolescent Idiopathic Scoliosis” (Katz, et al, JBJS-2010), and “Effect of Compliance Counseling on Brace Use and Success in Patients with Adolescent Idiopathic Scoliosis” (Karol, et al, JBJS-2016)]


Click here for the one-pager!


Texas’ Team Physicians Need Legal Protection When Traveling

“Treating athletes on the road is a fact of life for sports medicine professionals and they should be able to do so without facing unnecessary legal risks,” Senator Amy Klobuchar (D-Minnesota)


The Problem

Team physicians are generally licensed by their home state.  As a result, when they travel with their athletic teams across state lines to out-of-state events, they are working without a license.

The Solution

California, Louisiana, Florida, and Illinois are among the state legislatures that have passed laws to protect out-of-state team physicians who provide care when their teams visit those states. The state of Texas has not done so.

Please contact your state representative and senator and ask them to co-sponsor HB 986 and SB 849.  The bill would protect out-of-state team physicians when they travel to Texas for athletic competitions.

By doing so, this would encourage the remaining states to enact a similar law so that Texas’ team physicians are protected when they travel to the 49 other states.

We Need Your Help

All of Texas’ team physicians and their patients are encouraged to reach out to state lawmakers to educate them about the issue.  The process is simple:

  1. Below, fill out your address and generate an e-mail to be sent to your state representative and senator.
  2. If you would like to add a personal message to the text, please do.
  3. Please identify yourself and the sports team(s) that you cover.

Click here to download our one-pager