Stories from Texas Medicine, May 2015

Balance-Billing Ban Back in 2015 Legislature - 04/27/2018

Renewed attention in the 2015 Texas Legislative over balance billing stems in part from interim charges that tasked the Senate State Affairs and House Insurance committees to look at whether existing laws dating back to 2007 are working to inform patients ahead of time when out-of-network physicians might balance-bill them for services their health plans don't fully cover. The issue is in the national spotlight, too, with the proliferation of high-deductible and narrow-network plans sold in the Accountable Care Act insurance marketplace. New federal rules take aim at ACA plans' inadequate networks and inaccurate physician and hospital directories. The Texas Medical Association is pushing for similar health plan accountability measures at the state level, with a careful eye on legislation that could restrict out-of-network physicians' ability to balance-bill for services they legitimately provide.


Standing Up for Patients - 04/25/2018

The Affordable Care Act promotes collaboration and team treatment of patients. The Texas Medical Association agrees collaborative care is crucial, but the association wants to ensure physicians remain the head of the team. With the Texas Legislature in full swing, physicians face several bills that would challenge that leadership and expand the scope of practice for nurses, chiropractors, and other health professionals without a license to practice medicine.


We Got It Wrong - 05/13/2016

In a surprise move, the American Board of Internal Medicine (ABIM) is changing and suspending several recent revisions to its maintenance-of-certification (MOC) program, and physicians are cautiously optimistic the announcement heeds medicine's call for a process that remains relevant to clinical practice. In addition to some modifications to board exams and fees, a significant portion of the changes impacts newer MOC requirements for physicians to demonstrate quality improvements within their practices. ABIM put those programs on hold for two years. Other ABIM requirements remain unchanged.


The Next Phase of Cancer Care - 05/13/2016

The success of cancer treatments brings new issues to light, including how physicians — both specialists and primary care physicians — can support patients once active treatment is over. Survivor care plans, though not as common as they should be, are an important part of any survivor's aftercare. The plans include a summary of the patient's diagnosis and treatments, as well as a course of action for screenings, office visits, and lifestyle recommendations.


Room to Grow - 05/13/2016

Graduate medical education (GME) expansion is the top priority for medicine this legislative session, and thanks to years of advocacy coming to fruition, the issue is top of mind for lawmakers, too. As this story went to press, more GME money made its way into budget proposals, and a handful of bills build on the momentum started last session to grow the physician workforce in Texas with the creation of additional GME grant and physician education loan repayment programs.


Cutting Edge - 05/13/2016

TMA PracticeEdge offers physicians the technology and business know-how to compete with large health care systems, while maintaining their independent practices. The new company, which is controlled by the Texas Medical Association in partnership with Blue Cross and Blue Shield of Texas, helps independent practices band together to form a physician-led accountable care organization (ACO). The practices remain independent, but they sign a participation agreement to form a new legal entity with its own tax ID so it can receive payments from third-party payers and distribute the money to physicians within the ACO. TMA PracticeEdge offers consulting from certified professional coders, medical auditors, and compliance officers to all practices, including those uninterested in joining an ACO.