Stories written by Joey Berlin

Not Seeing Eye to Eye: Physician Employment of Optometrists Tested - 01/15/2020

A state board’s concerns over stopping conflicts of interest and a physician’s right to employ and delegate treatment to other professionals are colliding head-on. Now, it’s up to Texas Attorney General Ken Paxton to sort out what, in his view, the state’s optometry law allows.


Preserving Do No Harm: Supreme Court Tosses Challenge to Medical Ethics Committee Law. - 01/15/2020

Twenty years after it took effect, Texas’ medical ethics committee review law has withstood challenge after challenge. The Texas Supreme Court is on the verge of ending the latest high-profile attack on the law that ensures physicians can uphold their professional obligation to “do no harm.” In October 2019, the state’s high court declined to take up Kelly v. Houston Methodist Hospital, in which the mother of a deceased patient attempted to overturn a provision of the Texas Advance Directives Act. Justices’ action leaves intact an appeals court decision that preserves physicians’ ability to use their medical judgment in end-of-life cases.


Appropriate Use of Time? Medicare Rules for Advanced Imaging Orders Pose Prior-Auth Burdens - 01/15/2020

An effective way to cut down on overuse of potentially harmful imaging, or a prior authorization-esque burden on physicians who order needed tests? Texas physicians see Medicare’s “appropriate use” system for advanced imaging both ways. As of Jan. 1, physicians ordering advanced imaging tests for Medicare patients must consult an electronic portal, which evaluates whether the test meets Medicare’s own “appropriate use criteria” for whether a test should be ordered. Then when the claim is filed, physicians must document that they checked the system and its determination.


TDI Explains Arbitration Law Process - 01/15/2020

Before you’re involved in an out-of-network medical bill dispute that would be covered by the state’s new baseball-style arbitration law, it’s best to know what could be in store.  The Texas Department of Insurance has provided further details on how the law will be implemented, including how the arbitration process will work.


Insurance Commissioner to Health Plans: Be Proactive on New Surprise Billing Law - 01/09/2020

In a letter Tuesday addressed to “the health plans of Texas,” the Texas Department of Insurance (TDI) commissioner said TDI will monitor how health plans implement Senate Bill 1264, passed during last year’s session of the Texas Legislature and now in effect.


Finally Settled: Hospitals Settle Physician's Anti-Competition Lawsuit - 01/08/2020

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.


Changes Coming to Certain Informed Consent Forms - 01/02/2020

The Texas Medical Disclosure Panel has adopted changes to two informed consent forms, which will take effect at the beginning of 2020. The panel made amendments to its Disclosure and Consent for Medical Care and Surgical Procedures form and its Disclosure and Consent for Hysterectomy form.


An Injury to Justice: Workers' Comp Disputes Could Tilt in Insurers' Favor - 01/02/2020

Medicine is working to upend a recent appeals court decision that threatens to give health plans an overwhelming advantage in fee disputes in workers compensation cases.


Supporting Fair APM Payments: AMA Backs Accounting for Social Determinants of Health - 01/02/2020

Alternative payment models (APMs) are considered a key part of the future of value-based care. But for them to be successful, the American Medical Association says, APMs need to be fair, which means adjusting for the circumstances that make physicians’ cost and care challenges unique.


An Unfair Game: Quality Payment Program Rules Still Stacked Against Physicians - 01/02/2020

What the Quality Payment Program (QPP) lacks in simplicity, it makes up for in deck-stacking. After three years of physician participation, Medicare’s quality program to drive value-based care continues to generate confusion, frustration, and worry that it’s only going to swallow up more physicians in its complex and financially punitive gameplay.


State Adopts Emergency Rule on Surprise Billing Law - 12/20/2019

The Texas Department of Insurance has adopted an emergency rule outlining the narrow circumstances when it will be legal for physicians to balance bill patients under the state’s new law that protects patients from surprise medical bills. And the Texas Medical Board is telling physicians to accept how TDI interprets the law in its emergency rule.


TMA Supports Medical Ethics Committee Review Law in Latest Challenge - 12/20/2019

TMA has joined several other organizations on a friend-of-the-court brief in a case challenging the state's medical ethics committee review law. In the most recent challenge, the mother of a 10-month-old girl who since birth has been on life-support at Cook Children’s Medical Center in Fort Worth, has sued the hospital and obtained a temporary restraining order to keep her daughter on life support.


Texas' New Surprise Billing Law: Are You Ready? - 12/20/2019

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.


New House Committee Takes on Health Care Costs - 12/16/2019

Two physician legislators will serve on a newly created House Select Committee on Statewide Health Care Costs during the Texas Legislature’s interim year in 2020. The committee will examine the “primary drivers of increased health care costs in Texas.  


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.  


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.