Testimony: HB 3753 by Rep. Phil King (R-Weatherford)
Re: Physician Employment, before House Urban Affairs
By: Bruce Malone, MD
Wednesday, April 13
Mister Chairman, members of the committee, I am Dr. Bruce Malone of Austin. I am an orthopedic surgeon in Austin and President Elect of the Texas Medical Association. I speak on behalf of the 45,000 members of the Texas Medical Association in opposition to HB 3753.
TMA has reached an agreement with the Texas Hospital Association and the Texas Organization of Rural and Community Hospitals (TORCH) to support legislation to allow direct employment of physicians – with significant protections for physicians’ clinical autonomy – in rural hospitals, in our smallest communities.
Senate Bill 894 and its companion, House Bill 1700, apply to hospitals that are designated as
- Critical access hospitals
- Sole community hospitals and
- In Counties under 50,000 population
These parameters are not ours but are the ones proposed by THA and TORCH to which we agreed.
We have supported these bills to help our smallest rural communities compete in recruiting the physicians they need – now and in the future….
- And to compete against hospitals in urban and suburban areas which already have formed Non Profit Health Care Corporations (commonly called 501a corporations).
- And for West Texas and the Panhandle, to compete against hospitals and communities across the border where hospitals can, and do, hire physicians.
- We protect physicians’ independent medical judgment, specifically, and drive the supervision of all the aspects of clinical issues – from credentialing, privileges, peer review, etc – to the hospital’s medical staff.
- We require the medical staff to designate a Chief Medical Officer, with the approval of the hospital’s Board, to serve as the point of contact for the Texas Medical Board and to report to the TMB any interference which the CMO believes, in good faith, constitutes and interference in the practice of medicine.
House Bill 3753 is aimed at one hospital, Wise Regional, in Decatur, Texas. Wise is a fine facility, but it is not a Critical Access Hospital. It is not designated as a Sole Community Hospital, and Wise County itself has a population of nearly 60,000. By any measure, if falls outside the parameters of our agreement on Senate Bill 894.
More to the point, Wise Regional does not fit the profile of a struggling, rural hospital. While Decatur is a relatively small town, Wise County itself is growing rapidly as the Fort Worth metropolitan area expands to the northwest.
Wise Regional is a relatively new, four-year old, 99 bed hospital with over 200 physicians on its medical staff. And it already employs six physicians through its Non Profit Health Care Corporation. And I am sure, with prospects for many more.
The hospital is, in many ways, poised to serve not only its immediate community but the region at large. It seems well positioned now and in the future to serve patients from a wide area.
One factor why this bill is being pursued is the apparent expense of administering its Non Profit Health Care Corporation. Previous testimony alluded to a cost of some $200,000. I am not sure what is included in this…if it is related to health and other insurance benefits for the physicians employed or what other costs. It seems high, but I have no way of knowing for sure.
But it is in effect and the concept seems to work well for larger hospitals. It is a mechanism that more than 300 urban and suburban hospitals around the state have used to employ probably several thousand physicians. They do so seamlessly and presumably at a reasonable cost or there would not be so many of them.
But we have heard for the past several years that the mechanism of a Non Profit Health Care Corporation is too costly and administratively cumbersome for small rural hospitals. And that is why we have agreed with TORCH and THA to support SB 894. SB 894 is meant to address, in a structured way, the needs of small, underserved rural communities who are having difficulty recruiting physicians. And to do so in a way that protects patient care and that levels the playing field so that the smaller communities might compete against the urban and suburban facilities.
We oppose House Bill 3755 because it falls outside our agreement on SB 894 and HB 1700 to help our small communities and hospitals recruit the physicians they need. With over 200 physicians on its medical staff, and six employed physicians serving its community, it has robust medical resources serving a wide area.
Mostly we oppose this bill because we are committed to the agreement we have reached on SB 894 to help smaller hospitals and communities. And we believe the bill would dilute the intended effects and benefits that SB 894 will bring to rural communities.
82nd Texas Legislature Testimonies