Physicians – not lawyers or accountants – should manage patient care, Texas physicians say.
It’s the physician’s credo: Responsibility to the patient is paramount. Patients trust their physicians to do what is best for their individual circumstances, and physicians know that each patient is unique and requires undivided attention. But the corporations that manage the business end of health care exist to make money. And that’s why physicians are the last line of defense between a patient and a corporation’s bottom line, says Austin hospitalist Dieter Martin, MD.
When doctors talk about the corporate practice of medicine, they mean the usurpation by a nonphysician of a physician’s diagnostic, treatment, prescribing, and referral authority and responsibility.
And when Texas physicians talk about tort reform, they mean the 2003 medical liability reforms that put a stop to an epidemic of lawsuit abuse and pulled the plug on some unscrupulous trial attorneys’ games of “jackpot justice.”
In the 2019 session of the Texas Legislature, physicians are fighting to preserve the landmark 2003 law and maintain Texas’ ban on the corporate practice of medicine.
Consider the impact when administrators, not physicians, make critical medical decisions. Micromanagement of length-of-stay data, not the clinical assessment of a patient’s recovery, determines when a patient should be discharged from a hospital – even if he or she isn’t ready to go home yet.
“It is not uncommon for hospitals to tack on additional costs based on lab results” that are based on diagnostic codes determined by physicians, Dr. Martin said. “Like if labs indicate something like malnutrition. That’s not why the patient came to the hospital, and [it] will be coincidentally resolved through treatment. But hospitals bill for it, which ultimately costs the patient more.”
Unfortunately, situations like that happen routinely across Texas, even though the corporate practice of medicine is illegal. And when physicians object, and contracts are threatened, they have few options: acquiesce, or find themselves out of work. And in a state already facing a shortage of physicians, that’s no option.
The Texas Medical Association’s Healthy Vision 2025 – released last week – draws a roadmap for how legislators can ensure that physicians are the ones treating their patients, not analysts or the finance department. Recommendations to the Texas Legislature include:
Protect physicians’ independent medical judgment and clinical autonomy when lay control can interfere with best practices;
- Ensure that transparent due process provisions are included in all contracts, and that physicians employed by lay owned or run entities have a fair disciplinary or termination “for cause” process;
- Prohibit retaliation against employed physicians for reporting quality of care concerns or advocating for patient safety and the quality of medical or hospital care;
- Establish a more robust process at the Texas Medical Board for receiving and investigating complaints against nonprofit health organizations; and
- Pass no legislation that allows the government or corporate entities to dictate care that prevents physicians from exercising their moral or ethical conscience, or from providing medically appropriate care.
On the medical liability reform front, both physicians and the trial bar recognize that tort reform is a never-ending political and legislative battleground in Texas. TMA will guard against direct attacks on the 2003 law, under which the number of physicians practicing in Texas has grown even faster than our exploding population.
TMA recommends that the Texas Legislature:
- Protect the caps on noneconomic damages in medical liability cases but continue to allow unlimited economic damages.
- Maintain the special liability standard for emergency department services, obstetrical units, and emergency surgery.
TMA staff and leaders already have delivered Healthy Vision 2025 to all 181 members of the legislature, to the Capitol press corps, and to other key players. Through this week, a TMA campaign of paid advertisements and social media outreach will further promote the document and its legislative recommendations.
How can you get involved?