JamesLHollyMD.com

	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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Transforming Your Practice - New Transformation Tools

This section will display new transformation tools. This is consistent with the pursuit of excellence, as excellence is not a stop sign at which you arrive but it is a direction in which you are continually moving; so, transformation is never finished. Peter Senge talks about the gap between your “reality” - where you are - and your “vision,” where you want to be. When you can hold both in your mind at the same time, you develop “creative tension” which drives you forward, as tension always seeks a resolution. The reality is, that when the tension has driven you to where your vision becomes your new reality, your vision will have changed and it will drive you forward more than you originally envisioned. The following are recent developments in SETMA and are thus displayed here.

Chronic Care Management Code (CCM) Tutorial

Current format of The Chronic Care Management (CCM) Code was instituted by CMS in January 2015. It was first proposed in 2013 with a projection of beginning in 2014, but the requirements were such that it would have been virtually impossible for a primary care provider to successfully use it.

When the final version was released, changes had been made such that it could be used. Because the compliance requirements were specific and significant, SETMA decided not to deploy it until we had built a tool so that we could efficiently fulfill the billing demands and so that we could internally audit those requirements to prove that we were meeting all of the demands. The tool would also allow us easily to respond to a CMS audit if one were initiated.

SETMA’s deployment of Chronic Care Management can be found on the AAA Home template, as shown below outlined in green

e-Prescribing of Controlled Substances (ePCS)

ePCS and High Intensity Drug Trafficking Areas (HIDTA) Program

All Southeast Texas Medical Associates, LLP physicians can now prescribe controlled substances electronically (ePCS). A smaller group of SETMA physicians has been experimenting with this function for the past six months and now all physicians are authorized to use it,. This is another major step in the safe and effective use of controlled substances and places SETMA in the company of only 4% of physicians nationally who are currently using this function.

In the August 20, 2015 Examiner, this column discussed SETMA’s addressing of the “conundrum for patient and provider use of pain medications”: see Your Life Your Health - Prescribing Pain Medications: A Conundrum for Patient and Provider. The “conundrum” is created by the tension which exists between

patients who need pain medications and other medications which are subject to abuse,
providers who want to properly treat patients with these medications,
an increasing abuse of pain medications and
increasing demands by the Texas Medical Board upon physicians who prescribe these medications.

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