TMA Testimony by David Teuscher, MD
House Government Efficiency and Reform Committee
House Bill 595
March 11, 2013
Chairman Harper Brown and members of the committee, my name is David Teuscher. I am an orthopaedic surgeon in Beaumont and a member of the Texas Medical Association’s Board of Trustees. On behalf of TMA and its 47,000 physicians and medical student members, I would like to thank you for the opportunity to submit testimony regarding House Bill 595 by Rep. Lois Kolkhorst regarding the continuation of duties by the Department of State Health Services (DSHS) and Chapter 108.
The physicians of Texas support effective, safe, and timely care, and patients’ ability to make informed personal health care decisions. As an owner of a hospital in Beaumont, I have been required to report data to the Texas Health Care Information Council (THCIC) for more than a decade. While I support data collection to improve patient safety and quality outcomes, the heavy handed regulatory burden of reporting in Texas is not delivering such a result. The intention of any laws and their subsequent regulations should ultimately benefit patients who need tools to understand and make informed choices when they need medical services from their physicians and health care facilities. However, neither I, as a physician whose facility has had to report data to the THCIC, nor Texas physicians support bill language that continues a data collection program, such as THCIC that:
- Collects billing information that is then sold to third parties for financial purposes;
- Neither ensures nor enhances patient safety or quality outcomes; and
- Is expensive and time intensive for many providers to comply with these reporting requirements.
Unfortunately, parts of the state’s THCIC data collection program fit those categories. In some cases, the program simply focuses on billing information, which does not lead to quality or safety data. While the purpose may have been to help patients learn more about the health care system, it has never served that purpose in the past 20 years of its existence. It failed to provide patients with useful information about safety and quality. Instead, this data simply is sold to third parties, such as large hospital systems and commercial health insurance plans, who then use it primarily for market strategy purposes. Many of these purchasers are out of state (See the attached list of purchasers, PDF).
The DSHS Annual Survey of Hospitals (ASH) and Annual Statement of Community Benefits forms (ASCB) also demand data reporting requirements that burden physicians and health care providers and are of dubious and questionable benefit to the consumer/patients they serve. State laws (Health and Safety Code, Chapters 104, 311C, D, and 311.045(f)) require DSHS to collect aggregate financial, utilization, and other data from all licensed hospitals, yet there has been little if any actionable feedback shared with the facilities and physicians to benchmark best practices for safety and quality-of-care improvement.
Texas patients and health care providers would benefit by lightening the heavy hand of regulatory compliance costs. We would encourage the legislature to eliminate data collection programs within DSHS, such as parts of THCIC, ASH, and, ASCB, that do not give patients information about quality. We also believe the state should revisit all its data collection programs to see where they duplicate the data collection efforts of Medicare.
The state’s exhaustive billing-code data collection programs pull valuable hospital and ambulatory surgery center (ASC) employee resources within those reporting facilities away from collecting useful data that actually provides valuable information about safety and quality, such as those implemented by the Centers for Medicare & Medicaid (CMS).
Medicare has implemented an impressive patient satisfaction and clinical process of care (value-based purchasing) transparency program that actually provides useful information to patients. In addition, this transparency led to increased efforts by hospitals to enhance its patient satisfaction and clinical process of care standards. In many cases, the state is unable to duplicate Medicare’s already extensive quality and efficiency data releases. Medicare is expanding this program to include ASCs and will soon do the same for physicians. Texas should not require duplicate data in alternate reporting formats already collected and published by the CMS and readily available on its website at http://www.medicare.gov/hospitalcompare/.
Just last week, the Texas Department of Insurance (TDI) announced the redesign of its Health Insurance Rates Reimbursement Consumer Information Guide. TDI collected and compiled aggregated claims data submitted by the health plans for many common professional and hospital-based medical procedures. This data, required by SB 1731(R-80th), was then formatted to allow consumers to compare both in-network and out-of-network amounts for inpatient and outpatient services. The information on TDI’s website (https://wwwapps.tdi.state.tx.us/inter/asproot/life/reimbursement/index.asp) allows consumers to see and compare the average rates in different regions of the state.
This website states that a consumer could use this guide to:
- Estimate costs before you have a procedure.
- Understand cost variations across regions.
- Help you make informed decisions when you are able to plan for medical services.
As you can see, these CMS and TDI programs provide more practical use to the consumers of Texas to determine quality, outcomes, and costs.
In closing, I urge you to sunset costly and burdensome data reporting programs, such as the THCIC that have so far proven to be of little benefit to enhance quality, safety, transparency, and patient value. They have only succeeded in being a regulatory burden for health care providers and have done little to empower consumers to make informed health care decisions.
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