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TMA Physicians and Legislators: "Patients Have a Right to Know"
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The
Texas Medical Association (TMA) joined with state legislators
to launch initiatives today that would make using health
insurance better and much easier for Texas patients.
The
problem: Too often patients do not understand their health |
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insurance
information and cannot easily find the answers.
"We believe our
patients have the right to know what's covered in their insurance," said
Josie R. Williams, MD, TMA's president. "Our patients also have the
right to know which doctors and hospitals are in their network, how much
extra they will have to pay for the health care services they receive,
and why they have to keep paying more for health insurance."
That is why TMA
launched its grassroots outreach campaign, Patients' Right to Know. The
goal of the campaign is to engage Texas patients in the effort to pass
legislation that would reform health insurance.
Several state
lawmakers have introduced important legislation that will ensure
that patients have the right to accurate and
current information on copays, deductibles, and health plan networks to
make good health care decisions.
Health Insurance Code of Conduct Act of 2009
The
first piece of legislation to bring needed improvements to the health
insurance industry is the Health
Insurance Code of
Conduct Act of 2009.
The measure was filed
by Sen. Kip Averitt (R-Waco) and Rep. Craig Eiland (D-Galveston) in the
Senate and the House as Senate Bill 1257 and House Bill 2750,
respectively.
The Health
Insurance Code of Conduct Act of 2009 would:
·
Require
health plans to receive input from an outside party before they could
cancel the insurance of a very ill or injured patient who starts to run
up high medical bills;
·
Prevent
health plans from increasing the cost of insurance for no reason;
·
Help
patients and employers determine how much of their money the insurance
companies actually spend on health care, vs. advertising or big bonuses,
or profits;
·
Prevent
health insurance companies from selling doctors' contracts behind their
backs (they're fooling the doctors and making patients pay for it); and
·
Make
health insurance companies stop trying to tell patients that some
doctors are better than others based on the insurance claims. That's
like saying a restaurant's food is good or bad just by looking at the
bill at the end of the meal.
"We think it's about time health insurance companies treated our
patients like valued customers, and keep the promises they make," added
Dr. Williams.
Health
Insurance
"Soup Can Label" Bill
For many people, understanding which insurance to buy is difficult.
So physicians wonder, what if patients could understand what's in their
health insurance policy as easily as they can see what's in a can of
soup? What if patients could compare two different health plans as
easily as they can compare the calories in two different jars of peanut
butter?
TMA's health insurance label plan, filed by Sen. Kirk Watson
(D-Austin) and Rep. Senfronia Thompson (D-Houston), would do just that.
SB 815 and HB 1932 would require a standardized format for health plan
marketing materials that allows an "apples-to-apples" comparison of
health insurance coverage.
"Buying health insurance today is very complicated," said Dr.
Williams. She added that big insurance companies offer dozens of
different plans, and cover different things. Patients' out-of-pocket
costs can vary wildly. "It is almost impossible to compare what each
plan might mean to patients, their family, or business owners'
employees, and we think it's time big insurance makes this simpler for
patients."
The Patients' Right
to Know campaign calls on patients and physicians to help make health
insurance more accessible and transparent. Among other tools, TMA
created
www.meandmydoctor.com, a Web site with a grassroots action center
where patients can write their legislators in support of health
insurance reform bills. Educational materials will be displayed in
physician offices to inform and engage patients.
Other health
insurance reform bills being filed:
·
Sen.
Wendy Davis (D-Fort Worth) filed SB 1611, which would prohibit insurers
from arbitrarily revoking a patient's health insurance coverage. The
companion legislation to SB 1611 is HB 1748 by Rep. Todd Smith
(R-Euless). Senator Davis also filed three bills that would require
health insurers to disclose how they spend the patient's premium dollar.
Those bills are SBs 1155, 1156, and 1158.
·
Rep.
Carol Alvarado (D-Houston) filed HB 3120, relating to the maximum
allowable premium rate increase for small-employer health benefit plans.
·
HB 223
by Representative Eiland and SB 714 by Sen. Leticia Van de Putte (D-San
Antonio) would regulate how a physician's contract information is sold,
leased, or shared among health insurance companies.
·
HB 1392
by Rep. David Leibowitz (D-San Antonio) and SB 1396 by Sen. Robert
Deuell, MD (R- Greenville), would require health insurance companies to
use scientifically valid criteria to evaluate physicians' performance
and disclose those criteria in advance.
·
HBs
1369 and 1370 by Rep. Eddie Rodriguez (D-Austin) would provide
transparency about how insurers calculate patients' coinsurance, and
allow patients to accurately predict their out-of-pocket costs.
·
SB 901
by Senator Deuell, MD, relates to the collection of information
concerning data mining and pattern recognition by health plan benefit
insurers, and gives the Texas Department of Insurance the authority to
require health plans to report how they use this information.
·
HB 389
by Rep. John Zerwas, MD (R-Simonton), clarifies requirements for
expedited credentialing of physicians by health plans.
·
HB 390
by Representative Zerwas, MD, and SB 39 by Sen. Judith Zaffirini
(D-Laredo) would require health plans to pay patients' routine medical
costs when participating in a clinical trial.
·
HB 1342
by Rep. Jose Menendez (D-San Antonio) and SB 863 by Sen. Chris Harris
(R-Arlington) require health plans to provide pertinent patient coverage
information at the time of service.
TMA is
the largest state medical society in the nation, representing nearly
44,000 physician and medical student members. It is located in Austin
and has 120 component county medical societies around the state. TMA's
key objective since 1853 is to improve the health of all Texans.
Contact:
Pam
Udall (512) 370-1382; cell: (512) 413-6807;
e-mail:
pam.udall@texmed.org
Brent Annear (512)
370-1381; cell: (512) 656-7320;
e-mail:
brent.annear@texmed.org
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Texas District By
District: Judith Zaffirini
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Senator Judith
Zaffirini (D-Laredo) represents the 21st Senatorial District. The
second highest-ranking Texas state senator, she also is the
highest-ranking woman and Hispanic senator and the highest-ranking
senator for Bexar County and the border region. In 2008 she was
re-elected in a seventh landslide victory with 79 percent in the
primary and 68 percent in the general election. She has carried
all 17 counties in the large and diverse district in every
re-election, something no one else ever has accomplished.
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Lt. Gov. David Dewhurst appointed her
(2009) Chair of the Senate Higher Education Committee and member of
the Senate Finance, Health and Human Services, Economic Development,
and Administration committees. She is the first Hispanic woman senator
in Texas to serve as President Pro Tempore of the Texas Senate and as
Governor for a Day. She has served three consecutive terms as Chair of
the Senate Health and Human Services Committee, seven terms on the
Appropriations Conference Committee, eight terms on the Senate Finance
Committee, ten terms on the Senate Education Committee and on the
Legislative Budget Board since 2004.
Senator Zaffirini's legendary work ethic is reflected in her 100
percent perfect attendance record in the Texas Senate since 1987,
except for breaking quorum deliberately to prevent an untimely
re-redistricting that the U.S. Supreme Court (2006) ruled violated the
Voting Rights Act and disenfranchised voters in SD 21. Continuing her
unique career-long 100 percent voting record, Senator Zaffirini cast
her 38,530th consecutive vote in 2007. She has sponsored and passed
581 bills and 51 substantive resolutions and co-sponsored and passed
another 278 bills. Her legislative priorities include improving public
education, higher education, and health and human services.
Senator Zaffirini has received more than 600 awards and honors for her
legislative, public service, and professional work, including more
than 100 in communications. Her 2008 awards include being named one of
the "100 Most Influential Hispanics" by Hispanic Business magazine;
"30 Stars Over Texas," Texas Council on Family Violence; Wind
Champion, Wind Coalition; La Madrina de Region Central Del Rio Bravo,
Middle Rio Grande Development Council; Outstanding Legislator and
Alpha Doe, Texas Deer Association; The Best of the Texas Senate,
Combined Law Enforcement Associations of Texas (CLEAT); Long Term Care
Champion, Texas Health Care Association; Early Care and Education
Champion, Texas Licensed Health Care Association; and Seρora
Internacional by the League of United Latin American Citizens (LULAC).
Interestingly, she was named "Sister Judith," an Honorary Nun, by the
Sisters of Mercy and Mercy Industries, and "Mr. South Texas" by the
Washington's Birthday Celebration Association.
Additionally, in 2008 Senator Zaffirini received eight awards from the
Press Women of Texas Association, who have recognized her
communications expertise repeatedly with national and statewide awards
for her publications, speeches, and public relations campaigns,
including annual statewide first-place awards; and two Best in Texas
Merit Awards from the Texas Public Relations Association, who earlier
awarded her Best of Texas Awards for her Governor for a Day event and
her first edition of 20 Dozen Tips for Better Communication and
Leadership Skills.
Dr. Zaffirini is an award-winning communication specialist with 13
years of teaching experience, including at the college and university
levels. The South Texas Press Association honored her for her
distinguished career in journalism and public service. Through her
business, Zaffirini Communications, she provides professional
communication services, including consulting, workshops and seminars,
one-on-one coaching, keynote addresses, and writing. A distinguished
communicator, educator, and leader, she holds B.S., M.A., and PhD
degrees from The University of Texas at Austin, each with a 3.9
grade-point average.
A lector at Blessed Sacrament Catholic Church and member of the Texas
Philosophical Society and of Phi Kappa Phi Honor Society, her
professional memberships include the Texas Press Women, Texas Public
Relations Association, International Communication Association, Speech
Communication Association, and Association for Borderlands Studies.
Judith and Carlos Zaffirini have been married for 44 years. Their son,
Carlos Jr., is a graduate of the UT McCombs School of Business and the
UT School of Law.
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This Week In Texas: Mignon
McGarry Memos
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By Mignon McGarry
TOA Legislative Advocate
TOA Online Version: All Memos
March 25, 2009, Wednesday
It is common for many insiders
in Austin to say that the only bill that the Texas
Legislature must pass each session is the budget. Budgets
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are difficult to pass when times are
tough and equally tough to pass in times of plenty as legislators
fight over competing priorities.
Rumor has it that the House Appropriations Committee is scheduled to
wrap up their work on the House version of the budget this weekend.
If things go according to schedule, the full House will then take up
its version of the budget sometime during the week after Easter
between April 13-17. The Senate Finance Committee has wrapped up its
budget work and plans to vote on the bill as soon as Monday. That
means the full Senate should see the budget on the Senate floor
possibly next Thursday, April 2nd. The Senate budget is said to spend
roughly $177 billion but it does not spend any funds from the Economic
Stabilization Fund, also known as the Rainy Day Fund. Senate
tradition dictates that members will discuss the budget for several
hours but will offer no amendments on the Senate floor. The House
follows no such tradition and generally requires members to "pre-file"
amendments so that their fiscal impact can be determined and copies
distributed to all members prior to the day's debate.
If
you are interested in more details about the state's budget, the House
Research Organization has published a report entitled
Fiscal 2010-11 State Budget:
Background on the Issues which provides additional
background information regarding major budget drivers. Click
here to view the report.
Rep. Todd Smith (R-Euless),
chair of the House Elections Committee, announced that his committee
will devote two days of hearings to the controversial Voter ID
legislation on April 6 and 7. The first day will be devoted to expert
testimony, with an equal number of people for and against the bill
invited. The second day will be for public testimony.
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David Teuscher, MD
Testifies Before Senator And Senate Republican Conference
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David
Teuscher, MD, Beaumont orthopaedic surgeon testified before
Senator Cornyn and the Senate Republican Conference March
16th. The SRC held a hearing on tort reform and Dr. Teuscher
was asked to testify regarding the positive effects of medical
liability reform in Texas and on patients' access to
healthcare.
These proceedings can be watched by clicking
here. Simply click on the Flash logo to watch it streaming
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Radiologists, Physicians Argue
Over Diagnostic Imaging Legislation
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By Bill Kidd
WorkCompCentral
A coalition of business
interests, insurers and radiologists wants Texas lawmakers
to approve legislation they argue is needed to regulate
diagnostic imaging to help control medical costs and improve
patient safety by preventing overuse of the technology.
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But the Texas Medical Association argues the proposals aren't
needed and could add to the burden of doctors and patients and are
prompted by radiologists' financial interests.
The
increasing use of diagnostic imaging and the accompanying costs has
raised nationwide concern in recent years, along with worries that
patients are being exposed to unnecessarily high doses of radiation.
While
there is no dispute that such diagnostic tests are needed in many cases
and may prevent patients from having to undergo exploratory surgery,
critics fear that some doctors are overusing them.
The
Government Accountability Office reports that the amount of money that
Medicare spent on medical imaging doubled during the period from 2000 to
2006 to approximately $14 billion.
According to a New York Times story published March 2, more than 95
million such tests are performed annually in the United States, at cost
of $100 billion.
The
story also reported that recent studies show between 20% and 50% of the
procedures should not have been done, because the results didn't assist
in diagnosing ailments or treating patients.
And
the National Council on Radiation Protection and Measurement has
announced that Americans are exposed to seven times more radiation from
medical imaging tests than they were in 1980.
The
Coalition for Ethical Imaging, which is pushing for adoption of the
bills pending in the Texas Legislature, is comprised of the Texas
Association of Business, Texas Association of Health Plans, Texas
Radiological Society and other groups of Texans who work in the field of
radiology.
The
coalition reports it represents nearly 23,000 Texans and more than
120,000 Texas businesses.
The
group supports Senate Bill 1461 by Sen. Robert Duncan, R-Lubbock, and
its companion bill in the House of Representatives, House Bill 2599 by
Rep. Senfronia Thompson, D-Houston.
Those
bills require registration of diagnostic imaging equipment and
accreditation of diagnostic imaging facilities.
The
measures also would address quality issues associated with diagnostic
imaging providers and attempt to determine the extent to which physician
ownership of advanced diagnostic imaging equipment influences the
decision to prescribe expensive tests.
In
addition, the coalition supports HB 2279 by Thompson, which addresses
billing practices related to diagnostic imaging, and SB 821 by Sen.
Florence Shapiro, R-Plano, which addresses minimum standards for
radiologist assistants.
Dr. Richard Strax [TMA member],
Houston, president of the Texas Radiological Society, told
WorkCompCentral Wednesday that Texas is "behind the curve nationally in
providing basic safeguards that ensure that advanced diagnostic services
are utilized appropriately."
The
proposed legislation would make "a tremendous difference in quality of
patient care," Strax said.
The
coalition reports the legislation "addresses four areas of concern that
significantly impact patient safety and rising health care costs,"
including:
-
Over-utilization of diagnostic imaging.
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Inadequate accreditation of scanning facilities and registration of
equipment.
-
Insufficient disclosure to patients when a physician has a financial
interest in the imaging equipment or facility to which they refer
patients.
-
Nontransparent billing practices.
The
group is focusing its efforts on magnetic resonance imaging (MRI),
computed tomography (CT) and positron emission tomography (PET).
The
coalition reports the bills would:
The
proposed legislation would not restrict physician ownership of
diagnostic imaging machines or equipment; affect X-rays, mammograms,
ultrasounds or other common tests frequently conducted at physicians'
offices; or create any "costly or administratively burdensome and
onerous" tasks for physicians, the coalition contends.
Strax
reported that diagnostic imaging costs "have become the fastest
increasing segment of our health care budget," and that the coalition
wants to assure that the money is being spent properly and that the
public is being protected.
The
legislation "is intended to get a handle on where the machines are and
who owns them," and to require minimum standards for performance for
diagnostic imaging tests as has been done by the Centers for Medicare
and Medicaid Services (CMS) in the case of mammograms, Strax said. CMS
is expected to enact similar standards for diagnostic imaging, he added.
"Radiologists won't profit from this," Strax reported. Radiologists
probably already are reading results from doctor-owned machines, he
commented.
Austin physician Dr. Albert Gros, chairman of the Texas Medical
Association's council on legislation, told WorkCompCentral the
association believes "the magnitude of the problems" being cited by the
coalition are "greatly exaggerated."
"We've been talking with those guys for a couple of years," Gros said.
He labeled the effort "somewhat disingenuous" on the part of the
radiologists, saying their concerns may be financial.
The
legislation targets MRI, PET and CT procedures but "not the lower-cost
procedures" such as mammograms and sonograms, Gros commented.
Gros
said the legislation would "create a lot of administrative hurdles for
physicians" and make it more difficult for them to treat patients
efficiently.
Many
orthopedic practices have MRI machines which enable orthopedists to
examine patients and interpret results "in real time," Gros commented.
The orthopedists are qualified to read and interpret the results, and
patients aren't required to go to another site for the tests, Gros said.
Disclosing whether the practice owns the machine could be handled by
posting a sign and requiring such a sign could be done by an agency
rule without the need for legislation, he said.
Dr. Cynthia Sherry [TMA member],
past president of the Texas Radiology Society and chairwoman of the
radiology department at Texas Health Presbyterian Hospital in Dallas,
disagrees that financial interests are the motivation for radiologists.
"Financially, we could lose or it could be a wash," Sherry said.
"The
basic drive here is that we're concerned about patient safety and
quality when it comes to imaging," Sherry reported. "We think if there
were more regulations on appropriate utilization and safety standards,
all patients would be better off ... and the economic burden would
improve."
Sherry said "some of the boom" in diagnostic imaging use may be due to
physician ownership of the imaging equipment and that a study could help
resolve that question.
Sherry acknowledges that the radiologists and the Texas Medical
Association "don't see eye to eye on this particular issue.
This
is one we disagree with them on."
To
reach additional information and the text of the bills, click
here
and type in the bill number.
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TOA
Legislative Update
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DIAGNOSTIC IMAGING
House Bill 2599 by Rep. Senfronia Thompson and its
companion Senate Bill 1461 by Sen. Robert Duncan would
require the registration of diagnostic imaging equipment and
accreditation of diagnostic imaging facilities. The
legislation would require physicians to disclose to patients
that they have a financial interest in the imaging
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This legislation is backed by a group
known as the Coalition for Ethical Imaging whose primary supporter is
the Texas Radiological Society. Several physician groups have formed
Imaging Allicance.org to advocate on behalf of access to quality
medical imaging.
DIRECT ACCESS TO PHYSICAL THERAPY
Senate Bill 433 by Sen. John Carona and its companion House
Bill 607 by Rep. David Farabee would allow the general public some
degree of direct access to physical therapists. Representatives of
TOA along with TMA have been working with Senator Carona and
Representative Farabee to determine is any type of agreed to
legislation can be developed. No hearings have been held as of yet
but we expect both of these bills to be heard in a committee hearing
since both legislators are committed to passing some type of
legislation on this subject.
PODIATRISTS
House Bill 1570 by Rep. Senfronia Thompson and its companion
Senate Bill 1751 by Sen. Mike Jackson address the reimbursement
under preferred provider benefit plans for services provided by
licensed podiatrists. The legislation requires that the methodology
used to compute the amount of payment or reimbursement for services or
procedures covered by the preferred provider contract is the same as
the methodology used to compute the amount of payment or reimbursement
when the services or procedures are provided by a physician.
SILENT PPOs
House Bill 223 by Rep. Craig Eiland and its companion SB 714
by Sen. Leticia Van de Putte would regulate entities acting as
contracting agents in the secondary market for certain physician
discounts. House Bill 223 was discussed in the House Insurance
Committee and is currently pending in that committee.
SMALL BUSINESS EXEMPTION FRANCHISE TAX
Several bills have been filed this session to increase the small
business exemption under the Texas franchise or margins tax from the
current $300,000 to $1 million. We expect this to be the only change
to the franchise tax that receives serious consideration by the
Legislature even though the fiscal cost of such a change would be
substantial. Once the primary "vehicle" for this change has been
identified, we will follow it closely as it could impact some smaller
medical practices.
STANDARD OF PROOF IN EMERGENCY CARE SITUATIONS
Senate Bill 152 by Sen. Rodney Ellis would eliminate the
willful and wanton standard of negligence for health care liability
claims arising out of the provision of emergency medical care by
individuals or entities who are regularly in the business of providing
emergency care. For all other physicians and providers, Senate Bill
152 changes the liability standard to willful or wanton instead of
willful and wanton. There is no companion bill in the House. Senate
Bill 152 will be discussed in the Senate State Affairs Committee on
Thursday, March 26th.
TEXAS DEPT. OF INSURANCE SUNSET BILL
Senate Bill 1007 by Sen. Glen Hegar and its companion House
Bill 2203 by Rep. Carl Isett address the sunset provisions for
the Texas Department of Insurance. Since the Sunset review of the
Division of Workers' Compensation was postponed until 2011, this
legislation does not address that division.
WORKERS COMPENSATION
49 bills addressing various components of the workers' compensation
system have been filed. The following bills deal specifically with
medical care associated with a workers' compensation claim:
HB 698 by Rep. John Zerwas/ SB 378 by Sen. Leticia Van
de Putte Relating to the designated doctor's examination under the
workers' compensation system.
HB 1166 by Rep. David Leibowitz Relating to certain
requirements for doctors providing professional services under the
workers' compensation system.
HB 2428 by Rep. Joe Deshotel Relating to immunity from
liability for doctors performing certain medical services at the
request of the Division of Workers' Compensation.
HB 3625 by Rep. Gary Elkins Relating to deadlines regarding
certain preauthorization requests affecting workers' compensation
health care networks.
HB 3821 by Rep. David Leibowitz Relating to waiver of an
insurer's right to contest compensability of certain workers'
compensation claims.
HB 3822 by Rep. David Leibowitz Relating to review of the
medical necessity of certain health care provided in connection with a
workers' compensation claim.
HB 3823 by Rep. David Leibowitz Relating to certifications of
maximum medical improvement and assignments of impairment ratings
under the workers' compensation system.
HB 4624 by Rep. Eddie Lucio III Relating to certain
requirements for doctors providing professional services under the
workers' compensation system.
SB 1696 by Sen. Steve Ogden Relating to workers' compensation
compensability disputes, examinations to define the compensable injury
and notifications to health care providers regarding compensability
disputes.
SB 1815 by Sen. Leticia Van de Putte Relating to immunity from
liability for doctors performing certain services at the request of
the division of workers' compensation of the Texas Department of
Insurance.
SB 1985 by Sen. Carlos Uresti Relating to workers'
compensation health care reimbursement policies and fee guidelines for
certain health care services.
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