Stories written by Joey Berlin

Texas' New Surprise Billing Law: Are You Ready? - 12/11/2019

Texas’ baseball-style arbitration law takes effect for certain out-of-network medical care beginning Jan. 1, 2020. It’s a big change from how disputes on out-of-network medical bills have been handled in the past – and you need to know how to navigate it. There are nuances to consider, and disciplinary action from the Texas Medical Board (TMB) may await you if you balance-bill in violation of the law. That’s why the Texas Medical Association has produced a digestible, seven-page summary of the surprise-billing law.


TMB Pulls Proposed Rule on Surprise Bills - 12/09/2019

The Texas Medical Board has withdrawn its proposed rules to implement pieces of the state’s new law introducing baseball-style arbitration on many out-of-network medical bills. At its meeting Friday, the board pulled down its rule proposal, saying in a statement that it “would not cover all providers under the statute.”


Out of Physicians' Hands: TMA Challenges Unfair Quality Measures on Medication Adherence - 12/04/2019

Only patients can pick up their own prescriptions, and only patients can propel that medication into their own bodies. Physicians can educate, emphasize, and admonish – but at the end of the day, they can’t restrain and “pill” a squirming, uncooperative patient like a dog or cat. It’s up to patients to do the right thing for themselves. Yet, some health plans’ quality programs are putting that onus on physicians – through medication adherence metrics that determine whether physicians and accountable care organizations (ACOs) in value-based contracts receive bonus payments.


Know Your ADA Obligations - 12/04/2019

If someone asked you about your training on federal requirements for accommodating patients with disabilities, would your answer sound something like this? “Oh golly. I have no idea. I’m sure I had to read or study something sometime. I’ve been doing this a long time. I’ve been a doctor for quite a while, so I suspect I had to learn it somewhere, but I don’t remember where.” That’s an actual answer from one internal medicine physician in a recent study of doctors’ knowledge of their legal obligations under the Americans with Disabilities Act (ADA). And if the results of that small study are any indication, many physicians might be lacking in their knowledge on the subject.  


Finally Settled: Hospitals Settle Physician's Anti-Competition Lawsuit - 12/04/2019

A Laredo oncologist confidentially settled a years-long lawsuit involving a pair of hospitals he alleged mischaracterized a past legal misfortune to terminate his privileges and eliminate his clinic from competing with the facilities.


Far-Reaching Implications: The Ripple Effects of Texas' Uninsured Rate - 12/04/2019

Data compiled by the Texas Medical Association and other organizations, as well as physicians’ own anecdotal experiences, show how 5 million uninsured patients in Texas become 5 million dominoes. As they fall, so do countless others representing the health of Texas: The economy and well-being of entire communities. The classmates and friends of uninsured children. And yes, the physicians who deal with the burdens of treating uninsured patients in emergency rooms and providing uncompensated care.


More Funds for Medicaid, Women’s Health Needed, TMA Tells HHSC - 12/02/2019

Bolstering Medicaid and enhancing women’s health services are once again on the Texas Medical Association’s agenda as it makes recommendations to the Texas Health and Human Services Commission (HHSC) for the agency’s 2022-23 budget requests.


House Will Study Behavioral Health, Early Childhood Intervention, and More - 12/02/2019

Among a number of health care-related topics, the Texas House of Representatives during the interim “off” year in 2020 will study the state’s behavioral health system, child trafficking prevention, and the effect of technology and “big data” on insurance. House Speaker Dennis Bonnen (R-Angleton) released the chamber’s interim charges last week.


Big Noises Big Issues: Health Care Takes Center Stage One Year Out From 2020 Election - 11/11/2019

One year from now, Texas voters will hit the polls. They’ll be voting for president, for Congress, and for seats in the Texas Legislature. At the state and national levels, health coverage, Medicaid access, and prescription drug costs have gotten plenty of attention already, and they’ll get plenty more between now and the closing of the polls on Nov. 3, 2020. Here’s a look at some of the major health care debates taking center stage during the 2020 election cycle, what voters are and will be hearing about, and what Texas Medical Association policy says on those particular issues.


Senate Committees Will Examine Uninsured Rate During Interim Year - 11/06/2019

Texas’ nation-leading uninsured rate will be under the state senate’s microscope in 2020 as part of the interim charges Lt. Gov. Dan Patrick has assigned to senate committees. The list of interim charges, released last week, directs the Senate Business & Commerce Committee to “[s]tudy and report on ways to … decrease the uninsured rate in Texas” as part of its examination of the cost of health care.


CMS Finalizes Changes to QPP, Medicare Fee Schedule - 11/04/2019

Changes to Medicare’s Quality Payment Program (QPP) finalized Friday include both wins and losses for medicine, according to Texas Medical Association staff's initial analysis of the QPP final rule for 2020.


Easing the Pain? Opioid Settlement Brings Valuable Funding to Fight Crisis - 11/01/2019

September 2019 brought what could become a major victory for the state’s handling of opioid addiction. Drug-maker Purdue Pharma – which faced thousands of lawsuits from cities and states, including Texas, for its role in the national opioid crisis – announced it had agreed to a settlement with 24 state attorneys general and other plaintiffs. The maker of OxyContin and other pain drugs says the agreement will provide more than $10 billion to address the epidemic.


Medicine to Congress: Don’t Give Health Plans More Leverage - 10/24/2019

The federal government should take a balanced approach to surprise medical bills that includes commercially reasonable upfront payments and independent arbitration, the Texas Medical Association and many other medical societies are telling key members of Congress.


Have Your Say on Texas’ New Surprise Billing Law - 10/16/2019

The Texas Department of Insurance (TDI) is holding a public hearing next week on rulemaking for the state’s new “baseball-style arbitration” law to address surprise medical bills. If you wish to speak at the meeting, TDI requests you submit written comments or a summary of your testimony by noon Friday, Oct. 18 “to facilitate a meaningful discussion.”


Charting Medicine’s Statehouse Progress: A Successful Legislative Session for Physicians - 10/08/2019

Legislation is just one piece of a healthy Texas. But it’s a big piece, and when the Texas Medical Association told the lawmakers of 2019 how it should fit, those legislators largely shaped it to what physicians and patients need. The house of medicine convinced lawmakers that raising the age to purchase tobacco to 21 was the right thing for the state’s present and future. Medicine also successfully persuaded the legislature and Gov. Greg Abbott to improve insurance network adequacy and directories, which will help with surprise medical bills.


Warning: Watch Your Referrals - 10/01/2019

Federal anti-kickback law has changed, and it’s gotten broader. As a result, you may need to re-examine your practice’s compensation arrangements. That includes payments for laboratory referrals.  


More Pain for Small Shops? 2020 Quality Program Rule Could Mean More Penalties - 10/01/2019

Small and solo practices already take the worst of the administrative and financial pounding the Quality Payment Program (QPP) dishes out each year. In the Texas Medical Association’s analysis, the government’s plans for the QPP in 2020 would make the situation even harder on those smaller shops. Since QPP’s birth in 2017, small practices have struggled with the demands and synapse-straining complexities of the program’s Merit-Based Incentive Payment System (MIPS). And TMA analysis shows the payment penalties those “have-not” practices incur fund the bonus payments earned by MIPS “haves” – often, larger practices with the resources to make the program work. Under the 2020 changes that the Centers for Medicare & Medicaid Services (CMS) has proposed, the maximum penalties for practices who don’t hit their MIPS targets will be larger than ever. But TMA’s review shows that MIPS – despite CMS’ claims to the contrary – isn’t getting any simpler.


No Docs of All Trades: Ruling Reinforces Expert Witness Reforms - 09/26/2019

Before Texas’ landmark liability reforms passed in 2003, gray areas in the law often led to serious green for people who sued physicians.


System Failure: Houston Practices Fight WellCare for Payment - 09/26/2019

Several Houston-area practices say a botched technology conversion by insurer WellCare after it acquired a Medicare Advantage plan led to prior authorization and network confusion, undue denials, and unpaid claims by the barrelful.


We Need to Come in Force: Physician-Lawmakers Look Ahead to 2021 - 09/18/2019

A panel of medicine’s representatives in the Texas Legislature said Saturday that 2019 was a good year for medicine in Austin, but unfinished business remains for the next session in 2021.


Telemedicine: Valuable, But Not a Panacea - 09/18/2019

Telemedicine can provide patients with considerable convenience and satisfaction, but challenges still exist with insurance payments and bottom-line value for individual physicians. That’s what physicians who have successfully integrated telemedicine into their practices told fellow doctors during Saturday’s Dawn Duster presentation at the 2019 Texas Medical Association Fall Conference.


Doctors Drive New Opioid Laws - 09/18/2019

Several new laws will affect how physicians practice and how they prescribe controlled substances, including a delay on required checks of the state’s prescription monitoring program (PMP); a limit on opioid prescriptions for acute pain; and a new electronic prescribing requirement coming in 2021.


Opioids and Pharmacy: PMP Extension Granted - 09/16/2019

When it came to opioids and pharmacy matters, some of the major pieces of medicine’s 2019 agenda came down to something everyone wishes they had more of: time. Physicians need it to get comfortable with a mandate to check the state’s prescription monitoring program (PMP). Patients need it to make sure the pain medications they’re prescribed do what the drugs are supposed to do. The legislature listened, and TMA achieved wins on both counts, as well as on increased transparency from pharmacy benefit managers (PBMs).


CRNAs Can’t Administer Anesthesia Unless Physician Delegates It, AG Rules - 09/12/2019

The state attorney general has agreed with the Texas Medical Association in an official opinion that keeps certified registered nurse anesthetists (CRNAs) from administering anesthesia without physician delegation.


United Healthcare Cuts Consults - 09/04/2019

United Healthcare is eliminating payment for consults in two phases – one that took effect June 1 for certain services, and their complete elimination starting in October. The change is an effort to align with the Centers for Medicare & Medicaid Services policy that eliminated payment for most consults in 2010, but it’s going to make it more difficult for many specialists to get compensated for the extra time and work those services require.