Texas physicians stood at a crossroads. On one side loomed the
mounting financial pressures and bureaucratic hassles of health
plans and government agencies. On the other, the specter of health
care lawsuit abuse. The path straight ahead -- providing quality
medical care in partnership with their patients -- seemed
Their ability to care for their patients increasingly
threatened, Texas doctors once again turned to America's best
medical society for help. And, once again, the Texas Medical
Association and its partner county and specialty medical societies
responded. With strong leadership, the 78th Texas Legislature
turned in a powerful performance on health care issues.
"As we have in years past on issues from tort reform to patient
protection, the 'doctor lobby' moved quickly and decisively to help
preserve our patients' ability to get the care they need," said TMA
President Charles W. Bailey Jr., MD. "We'll remember 2003 as an
incomparable legislative year for Texas physicians and their
Liability Reforms Will Help Restore
Constitutional Referendum Looms Large
It began in the "war zones" -- Beaumont, the Rio Grande Valley,
Corpus Christi, and Wichita Falls -- and was concentrated among
obstetricians, neurosurgeons, and trauma specialists. But health
care lawsuit abuse extended its tentacles to ensnarl nearly every
Texas physician. Unable to afford -- or find -- liability
insurance, doctors across Texas have been forced to cut back on
patient care, move, or consider early retirement.
The demand for relief became TMA's No. 1 priority for the 2003
Texas Legislature. Gov. Rick Perry heard the outcry. At TMA's
sesquicentennial celebration, he called for immediate action on
this statewide medical emergency. Working with other health care
organizations, TMA proposed a comprehensive solution grounded in a
nationwide search for proven antidotes to lawsuit abuse.
Despite tenacious trial lawyer opposition, TMA won a strong
package of reforms that far exceeds what other states have enacted
- Caps on noneconomic damages are $250,000 per occurrence for
all physicians; $250,000 per occurrence for a health care
institution; and a second $250,000 per occurrence for any
completely separate institution.
- Periodic payments are mandatory for future medical expenses
and permissible for others.
- Many procedural reforms on expert witness reports and
pretrial depositions will help prevent frivolous lawsuits.
- The definitions of a volunteer and a Good Samaritan were
broadened to protect physicians who provide this care.
Physicians and patients owe gratitude to Governor Perry, Lt.
Gov. David Dewhurst, and Speaker Tom Craddick for making sure these
critical reforms survived numerous assassination attempts. Rep. Joe
Nixon (R-Houston) and Sens. Bill Ratliff (R-Mount Pleasant) and
Jane Nelson (R-Lewisville) devoted hours listening to testimony,
writing and rewriting legislation, and working for its passage.
What It Means for You and Your Patients
The new law takes effect Sept. 1. It should begin to modulate
the number of health care liability claims filed and the severity
of judgments awarded. Settlement trends should follow. The
liability insurance market remains battered nationwide, but the
carriers still in Texas have all pledged significant reductions in
Relief will come much more quickly if Texas voters approve the
proposed constitutional amendment that will be on the ballot Sept.
13. The referendum will decide whether the legislature has the
authority to set caps on damages. Without passage, years of legal
wrangling would be necessary before the Texas courts could decide
the bill's constitutionality. All physicians need to go to the
polls; TMA will help you "get out the vote" among your office
staff, colleagues, friends, family, and patients.
*Passage of the Sept. 13 referendum would bring this grade up
to a solid "A."
Prompt Pay Bill Stronger Than Ever
New Law Takes Direct Aim at Plans'
Texas physicians' complaints that the profit-driven health plans
drag their feet paying claims have continued to escalate -- as have
the time and money medical practices spend chasing unpaid bills.
TMA studies found that at any point in time, every Texas HMO owes
physicians and other providers $1.2 billion. Well more than half of
all claims remain unpaid beyond the 45-day statutory limit. TMA's
physician surveys showed that 71 percent are having cash-flow
problems because insurers and other third-party payers aren't
paying claims in a timely manner.
Senator Nelson, who led a committee that investigated the
problem, and Reps. John Smithee (R-Amarillo) and Craig Eiland
(D-Galveston) worked closely with TMA to tackle the issue. With
technical advice from the Texas Medical Group Management
Association, they crafted a strong bill to counter the plans'
What It Means for You and Your Patients
- If a health plan tells you it will pay for a certain service
for a patient, it has to pay.
- Clean claims submitted electronically must be paid within 30
- Health plans will not be able to unilaterally change the
definition of a "clean claim" or make more than one request for
additional documents before processing a claim.
- Any coordination of payment disputes should not affect
whether a physician is paid.
- Health plans won't be allowed to "contract around" these
A standardized contract between physicians and health plans
would go a long way toward leveling the playing field. A bill
establishing such a standard failed to pass during this session.
TMA will continue to work on this issue.
Comprehensive Pro-Vaccination Bills Pass
New Laws Will Counter Public Health
Texas faces a critical public health challenge: Our children are
among the least immunized in the nation. Texas has no statewide
program to educate the public on the importance of immunizations.
The vaccine schedule has become more comprehensive -- and more
confusing. Vaccine shortages, both present and projected, compound
For more than a year, TMA's councils on Public Health and
Legislation worked with specialty societies and the Texas
Department of Health (TDH) to devise a legislative strategy to
reverse this unhealthy trend. Sen. Judith Zaffirini (D-Laredo) and
Rep. Jaime Capelo (D-Corpus Christi), carried a package of four
bills through the 2003 Legislature.
What It Means for You and Your Patients
- TDH will establish a continuous statewide public education
program -- like Shots Across Texas.
- TDH also will develop an outreach program to increase
physician participation in the state's immunization registry
- Participation in the Vaccines for Children program will be
easier for doctors' offices.
- Any parent can declare conscientious objection to immunizing
his or her child, who could still attend public schools.
- ImmTrac will hold more data and be more secure and less
cumbersome for physicians and parents. Physicians will have
immunity for providing information to the registry.
Patient Care Compromised by Deep Cuts in
Medicaid and CHIP
Devastating Medicaid Physician Rate Cuts
Legislators Bridge $10 Billion Shortfall
With No New Taxes
The first proposal to make up the $10 billion difference between
the projected need for state services and the available funds could
have destroyed Texas' health care infrastructure. TMA immediately
jumped on the offensive to fend off a proposed 33-percent cut in
physicians' Medicaid and Children's Health Insurance Program (CHIP)
fees, a plan to eliminate 200,000 children covered by CHIP, and
numerous other truly draconian cuts.
Record numbers of Texas doctors already felt they couldn't
afford to see new Medicaid patients; a new survey showed the
proposed reimbursement cuts would precipitate a crisis. TMA helped
commission a hard-hitting economic analysis that documented how
Medicaid and CHIP spending rippled positively through the economy.
The analysis showed how local taxpayers, employers and employees,
and doctors and hospitals would suffer if the legislature reduced
Medicaid and CHIP spending. TMA joined with a broad-based coalition
in proposing a $1-per-pack fee on cigarettes to finance state
health care programs.
The legislature refused to pass the cigarette fees or any new
taxes. It produced a balanced state budget with the aid of a
last-minute federal largesse, largely courtesy of U.S. Sens. Kay
Bailey Hutchison and John Cornyn, and an extremely optimistic
forecast of Medicaid and CHIP caseloads for 2004 and 2005. However,
the health care safety net for Texas' working families shrunk
significantly, and our network of Medicaid-providing physicians and
other providers remains unstable.
What it Means for You and Your Patients
- Medicaid and CHIP payments for physicians and other providers
will drop by 5 percent, but thanks to TMA action, the first new
federal dollars are scheduled to counteract that cut.
- Prior authorization will be required to prescribe medications
that are not on a new Preferred Drug List and for ill-defined
- As many as 8,000 pregnant women will lose Medicaid
- Medicaid managed care, including HMOs, may continue to
expand, but a TMA-backed amendment prohibits HMOs in the largest
counties along the Texas-Mexico border.
- The Medicaid Medically Needy Program was eliminated.
- Changes to CHIP eligibility and enrollment requirements will
eliminate coverage for 120,000 children. Children covered by CHIP
will also lose coverage for dental and mental health care;
durable medical equipment; and physical, occupational, and speech
Dangerous Scope-of-Practice Bills Rejected
Allied Health Care Providers Win No Unsafe New
In every legislative session, one or more groups of nonphysician
health care professionals seek to expand their scope of practice.
TMA values its collaborative relationships with the organizations
representing those professionals but insists that the legislature
protect patients by restricting those practitioners to services
within the scope of their education and training.
In sessions past, medicine has learned that a scope-of-practice
fight is not limited to the affected specialty. Once again in 2003,
TMA united with the family of medicine to stridently oppose several
efforts to expand scope of practice without the benefit of a
medical education. Many physicians joined their colleagues from
psychiatry, for example, in convincing our lawmakers that allowing
psychologists to prescribe medications in Texas would be a
high-risk experiment and a prescription for disaster.
What It Means for You and Your Patients
- Psychologists will not have prescribing authority.
- Physicians and chiropractors may not establish partnerships
and share profits.
- Chiropractors may not sign requests for temporary handicapped
- Acupuncturists will not have more independent authority to
treat stress, allergies, nausea and digestive disorders, or
- TMA leaders worked with the advanced practice nurses and
physician assistants to save political capital for doctors by
working out a package of pro-patient changes in those
Franchise Tax Expansion Defeated
Issue May Come Back in Special Session
Throughout the 2003 session, lawmakers looked for ways to expand
state revenue by closing loopholes in the state franchise tax.
Unfortunately, the legislature's bill drafters seemed unable to
find a rifle shot that would get them what they wanted. Every
"shotgun" franchise tax bill they considered would have extended
the tax onto many physicians who previously had not been subject to
it or would have increased the franchise tax bill for those
physicians who already pay it.
TMA argued that it would be bad public policy to tax physician
practices and that physicians have almost no way to pass along
taxes as a cost of doing business. No franchise tax bill made it
out of the House Ways and Means Committee. But Governor Perry has
promised a special session on public school financing, perhaps as
soon as this fall, and all state taxes likely will be reviewed as
part of that effort.
*Preventing expansion of the franchise tax to physicians
during the special session on school finance would bring this
grade up to a solid "A."