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	James L. Holly, M.D.

About SETMA Joint Commission Contact Information History Mission Statement Medical Home Scope of Services I-CARE Initiative Infusion Center The SETMA Way - What is it? SETMA's Model of Care Patient-Centered Medical Home The SETMA Approach to Patient Care	In The News Letters Vital Signs - Examiner Publication SETMA's Providers as of January, 2015 SETMA Knows - Abraham Lincoln and Healthcare Analytics SETMA – 1999 – Four Seminal Events PC-PCC Award January, 2015 Vital Signs Spring 2015 Vital Signs Q&A for PC-PCC Award Links to SETMA 2012 eHealth Innovator Award for LESS initiative Handout for Attendees eHealth Conference January 12, 2012 eHealth Initiative 2012 Award Program Application The eHealth Initiative's 2012 Award Letter 2012 National Quality Forum National Healthcare Improvement Award Effective prioritization of performance improvement goals Dashboard to Measure and Manage Whole System Performance Commitment to transparency Date-driven improvement of NQS priorities Demonstration of readiness to assume responsibilities of an ACO Demonstrated results on publicly reported performance measures Public Reporting Quality Metrics for 2009, 2010, 2011 Internally Tracked Reporting Quality Metrics for 2009, 2010, 2011 Complete Application in PDF Format SETMA's Medical Home Pilgrimage 2009 Medical Home Series I 2010 Medical Home Series II 2011 Medical Home Series Two 2009, 2010, 2011 Medical Home Miscellaneous Articles The Dr. and Mrs. James L. Holly Distinguished Professorship Universal American Letter of Transmittal for Support Dr. Holly's Acceptance Address for the 2012 Distinguished Alumnus Award CMS Medical Home Feedback Report Qualify & Cost SETMA questions Influenza Data SETMA I - October 2011 SETMA II - October 2011 Mark A. Wilson Clinic SETMA West - October 2011 SETMA and Fox 4 News - Healthy Living Videos SETMA Advertisements - Display and Video SETMA Announcements Featured Content Archive	Syllabus PC-MH Externship SETMA's MS4 Patient-Center Medical Home Selective Syllabus Introduction to SETMA's Senior Externship and Syllabus An Introduction to the Origins and Beginnings of Southeast Texas Medical Associates, LLP Patient-Centered Communication PC-MH Health Affairs August 15, 2013 Policy Brief -- Health Gap SETMA 8.20.13 Provider Training -- Health Affairs 2.14.13 -- Patient Engagement SETMA Provider Training 8.20.13 during First Senior Medical Student PC-MH Externship Medical Home Coordination Review Tutorial 2011 Medical Home Series Two Teaching Tool for PC-MH Course - Patient Care Activation, Engagement, Shared-Decision Making	Patient Information What Does Patient-Centered Medical Home Mean to You? What Does Patient-Centered Medical Home Mean to You? Health information exchange Patient Rights and Responsibilities Patient Directions Contact SETMA – Secure Texting What is HIPAA? Authorization To Release or Obtain Medical Records Complete Privacy Policy Website Privacy Policy	Presentations Invited Presentations SETMA Provider Training
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A Tutorial for Utilizing SETMA's Deployment of the STARS MA Program Specialized Tools Annual Questionnaires: Fall, Functional, Pain, Stress, Wellness Association of Medication & Diagnosis Chronic Conditions Tutorial Chronic Care Management Code (CCM) Tutorial Depression Tutorial Drug Interactions Tutorial Electronic Tickler File Tutorial Evaluation Lower Urinary Tract Symptoms in the Male Fall Risk Tutorial Future Labs Tutorial Hydration Assessment Tutorial HCC Risk Training Tool Hypertension: Fulfilling Quality Metrics for the PCPI Program Laboratory Results - Signing Off: Why and How Medication Module Tutorial Medication Reconciliation Tutorial Nutrition Tutorial Pain Management Tutorial Problem List Reconciliation Tutorial Progression to Type 2 Diabetes Referral Skin Care Tutorial SOAAP Opioid Risk Assessment Stratifying End-of-Life Risk for Hospice Services Tutorial Texas State Reportable Infectious Diseases Tutorial Transitions of Care Management Coding (TCM Code) Tutorial	Transforming Your Practice Library Introduction to SETMA's TCPI Library Transforming Your Practice (TCPI) Summary Document of TCPI CMS Quality 12.2015 TCPI Leadership and Governance Care Coordination HIPPA and Security Data Analytics Care Transitions LESS Initiative Medical Records Clinical Decision Support Hospital Care Tools Disease Management Tools Preventive Health Tools Behavioral Health Transformation Tools New Transformation Tools Patient-Centric Care Nursing Home Medical Home Display and Explanation of SETMA's Patient-Centered Medical Home Tools	Medical Home The Story and the Ideals Introduction to Preventive Health Tools PC-MH Patient Engagement & Alternative Payment Models Preventive Care: The Best Way to Treat Illness is Don’t Get it Coordination of Care Patient-Centric Care Population Health Transition of Care - 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About SETMA - SETMA’s Medical Home Scope of Services

Being a patient in SETMA’s patient-centered medical home means you have access to a wide range of other clinical support services. These services include:

Dietary Education through SETMA’s American Diabetes Association approved Diabetes Self Management Education program. SETMA’s education department also trains patients in dietary weight management, cholesterol control, the Dietary Approach to Stopping Hypertension (DASH), Renal Dietary management, and others.
Cardiovascular Laboratory in which you can be tested for heart disease with stress test, dobutrex Stress Test, echocardiograms, arterial Doppler, carotid Doppler, holter monitors, etc.
Pulmonary Function testing
Bone Densitometry for osteoporosis
Allergy Testing
Cardiovascular Risk Stratification with Carotid Intima Thickening testing
Ultrasonography for abdomen, pelvis, venous, etc.
Laboratory services – SETMA’s reference laboratory provides an extensive array of testing, all of which are link with the electronic medical record.
Radiologic services including Mobile x-ray
Physical Therapy which provides state-of-the-art to all patients for cardiac rehab, conditioning and all other modalities of physical therapy.
Infusion Center
Specialty Diabetes care through the Diabetes Center of Excellence at Southeast Texas Medical Associates.

SETMA continually studies, learns and innovates to bring outstanding care to all of our patients. SETMA’s multi-specialty care is available for:

Cardiology

Diabetes Educators

Dieticians

Family Medicine

Infectious Disease

Internist

Neurology

Nurse Practitioners

Pediatrics

Physical Therapist

>Rheumatology

Comprehensive Support is SETMA's Ancillary Healthcare Services for Nursing Homes and Home Health Agencies

Southeast Texas Medical Associates, LLP has designed comprehensive support services to assist you and your facility/agency in providing quality healthcare, in maintaining quality of life for your clients/residents, and in doing both in a cost-effective manner. SETMA's Comprehensive Support Services allows you to interact with one provider for all of the medically-related services which you need in order to operate your facility/agency in compliance with applicable laws and consistent with your commitment to excellence. SETMA looks forward to demonstrating our commitment to excellence in healthcare, to success for your facility/agency, and to doing both of these in a manner which is cost-effective for your agency. SETMA would be happy to discuss how we can customize these comprehensive support services to meet your needs.

Medical Director

The Medical Director of a residential nursing facility is an active participant in assuring quality care for the residents of the facility. The Medical Director's commitment to excellent care, expertise in geriatrics, ability to work with the administration to put in place protocols for quality patient care, and the Medical Director's participation in quality assurance and utilization review, all make him/her an invaluable member of your healthcare team.

SETMA offers Medical Director services to residential nursing facilities and to Home Health Agencies to facilitate their mission statement, to extend their services to others and to assure consistent quality care. SETMA is prepared to spend the necessary time, and in conjunction with Certified Family Nurse Practitioners, to oversee the medical care of each resident of the nursing facility and/or each client of the home health agency. SETMA's physicians are also prepared to work with other physicians who have patients in the facility and/or in the home health agency to insure timely provision of appropriate medical services.

Nurse Practitioners

Certified Family Nurse Practitioners are part of the professional staff at SETMA. SETMA currently employs 11 CFNP's. These healthcare colleagues provide SETMA with the capacity to extend excellent healthcare to even more residents of Southeast Texas. They also make it possible for SETMA to insure weekly, and if necessary, daily, follow-up on patients who have active medical problems.

The Texas Department of Human Services NFR-LMC 95-0 states:

"19.1205. Physician Delegation of Tasks. (a) In a Medicare skilled nursing facility (SNF), except as specified in subsection (b) of this section, a physician may delegate tasks to a physician assistant, nurse practitioner, or clinical nurse specialist ... (c) In a Medicaid nursing facility, any required physician task may also be satisfied when performed by a nurse practitioner, clinical nurse specialist, or physician assistant who is not an employee of the facility but who is working in collaboration with a physician ..."

The CFNP's associated with SETMA are excellent clinicians, will help maintain the health of your clients, and will help retain them in your facility. Transfers to the hospital for untreated and remedial problems will be decreased, client satisfaction will be increased, and the facility/agency's reputation will grow. There are no direct costs to the facility/agency for the services of the CFNP. Those services are charged to the patient on a fee-for-service basis. Also, all of SETMA's providers accept assignment of Medicare and Medicaid benefits.

Reference Laboratory Support

SETMA maintains a Medicare and Medicaid certified reference laboratory. The technical and professional support provided by this service, is an invaluable asset to SETMA's commitment to quality care for the residents/clients of your facility/agency. The validity of laboratory data is guaranteed by the CLIA certification and regular proficiency testing maintained by the SETMA staff. The relevance of laboratory data is guaranteed by the rapid availability of testing results because of SETMA's local ownership and location.

Your facility and/or agency will be proud to tell your clients that SETMA's reference laboratory provided your data, because then they will know that the results are valid, and that they are relevant to your residents/clients care. There are no direct costs to the facility/agency for laboratory services. These are billed to the patients' insurance. And, with SETMA's state-of-the-art Laboratory Information System, a permanent copy of all laboratory work is maintained by SETMA and is available upon request at any time by the facility/agency. This will greatly assist you with inspections and reviews.

SETMA can provide laboratory results by an on-site printer at your facility, or by a computer workstation, which will allow you to order tests from your facility. If you elect a workstation, fifty-percent of the initial cost of that workstation would be billed to the facility/agency.

Mobile X-ray and EKG Services

Through American Healthcare services, an independently owned and operated mobile x-ray and EKG service, SETMA’s patients are provided these services.

Drug Screening for Employees

Insuring a drug-free work environment is important in all companies, but with residential patient care it is critical. SETMA's comprehensive support is able to provide the facility with routine drug screening on a periodic basis and with individual drug screening when an incident occurs with a patient/client.

It is imperative that the facility assures residents they are being treated in a drug-free environment. When an accident occurs or when a patient-incident occurs, the facility should immediately take steps to assure themselves and the client's family or guardian that the incident was not related to drug usage by the employee. SETMA can assist with this program.

Other Ancillary Medical Services

Additional services can be contracted through SETMA. Some of these will be at a direct cost to the facility/agency, and some would not. SETMA's CFNPs have graduate degrees in Nursing Education, and are able to provide in-service training for your continuing education requirements. These services can be contracted at a very reasonable cost to your facility/agency.

SETMA can provide pulmonary function testing on-site at the facility/agency. This testing is done with twenty-first century technology, which provides pulse-oximetery testing and all other parameters necessary for evaluating the pulmonary status of your patients/clients.

SETMA participates in a number of public events each year for the purpose of providing free screening tests and for explaining who we are to the Southeast Texas community.

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