House Passes Measure to Prevent Medical Billing Tax
By Joey Berlin


Thanks to tireless work from a physician-legislator, the house of medicine took a huge step Tuesday toward preventing a planned tax on medical billing services that would take money out of patients’ and physicians’ pockets.  

House Bill 1445 by Rep. Tom Oliverson, MD (R-Cypress), which would legally classify medical billing services as not being insurance services, passed the Texas House of Representatives on Tuesday. That simple classification move would preemptively erase a tax of up to 8.25% that otherwise would hit outsourced medical billing services beginning this October. The billing organizations would be forced to pass that cost onto physicians, and patients would see a ripple effect as well. 

Along with Representative Oliverson, TMA received crucial help in advancing HB 1445 from the state comptroller’s office, which provided guidance to the house of medicine on crafting a legislative fix to avoid the tax. 

HB 1445 now heads to the Senate for consideration, where it must earn passage before heading to Gov. Greg Abbott’s desk for his signature. 

Improving – and protecting – TADA  

Measures dealing with the Texas Advance Directives Act (TADA) and end-of-life care were on the Senate Health and Human Services Committee’s agenda today, with one measure TMA strongly supports and one it opposes. With testimony on each, TMA hoped to help lawmakers strike the delicate balance between honoring patients’ and families’ wishes while also respecting physicians’ creed to “do no harm” when providing life-sustaining treatment. 

Medicine is firmly behind Senate Bill 1944 by Sen. Eddie Lucio (D-Brownsville) to improve TADA and give patients and their families greater understanding and notice of the state’s hospital ethics committee process to resolve disputes over end-of-life care. 

The bill would require ethics committees to appoint a liaison to assist a patient or patient surrogate through the process and give families greater advance notice of an ethics-committee hearing. The bill also would ensure that a patient’s surrogate would be able to revoke a patient’s do-not-resuscitate order (DNR) only if the order was originally issued at the surrogate’s direction. 

SB 1944 also corrects an error in 2017 legislation that prevents a physician from honoring a patient’s wishes if those wishes are communicated to the physician. As Dallas palliative medicine specialist Mark Casanova, MD, (pictured above) told the committee in written remarks, TMA agrees surrogates should be able change DNR decisions they’ve personally shared with a physician. 

“However, no one – not the surrogate, not the physician, not the hospital, nor any organization – should be able to undo a patient’s personal decision on a DNR,” Dr. Casanova wrote. 

SB 1944 would also extend the time a facility has to transfer a patient after an ethics committee makes its decision on the patient’s life-sustaining treatment, from the current 10 days in TADA to 14 days. 

On the other hand, Dr. Casanova told the committee TMA opposes Senate Bill 917 by Rep. Bryan Hughes (R-Mineola), which would require hospitals to provide medical treatments to an end-of-life patient indefinitely until the patient can be transferred to another facility. Those transfers don’t occur often. 

TMA’s primary concern is defending physicians’ right to exercise their moral or ethical conscience, which is severely constrained if they’re forced to indefinitely provide non-beneficial treatments. 

First Tuesdays at the Capitol  

About 150 physicians joined TMA leadership and members of TMA’s lobby team virtually yesterday for the penultimate edition of First Tuesdays at the Capitol. Attendees received a primer on TMA’s legislative push to curb prior authorization, expand coverage for low-income Texans, modernize the state’s immunization registry, and much more. 

TMA President Diana Fite, MD, urged attendees to work together to let legislators know where medicine stands on the key issues. She lauded the work the house of medicine has accomplished during a session of largely remote communication. 

“I can tell you right now, your calls and emails and the Zoom visits do make a difference,” she said.

The final First Tuesdays of the 2021 session is May 4. Register today to join TMA on the front lines for the session’s final turn. 

Declawing PBMs   

Austin oncologist Debra Patt, MD, chair of TMA’s Council on Legislation, stepped up Tuesday to show TMA’s support for a bill that would bar pharmacy benefit managers (PBMs) from “clawing back” money paid out in a claim for a prescription filled at on-site, practice-based pharmacies. 

Among a slew of other measures the House Insurance Committee examined on Tuesday was House Bill 1763 by Representative Oliverson, which would bar PBMs from using “direct and indirect remuneration (DIR) fees” to take shares of pharmacies’ insurance payments after a claim is complete. Dr. Patt testified about her personal experience with DIR fees. Her clinic, Texas Oncology, has an on-site pharmacy to provide patients with oral chemotherapy drugs, but paid out more than $16 million in DIR fees in 2020, she told the committee. 

“About five years ago, it was about 4% of total costs for the pharmacy. Today, it’s upwards of 11% of total costs for the pharmacy,” she testified. “And there are many drugs that we actually are under water on that we choose to dispense in our pharmacy because that’s better patient care, if on average we can break even with that. I’m on pharmacy management calls every week about these issues, and it is a substantial burden that is growing exponentially.” 

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Last Updated On

April 07, 2021

Originally Published On

April 07, 2021