Economic practices by health plans, employers, and hospitals gave the Texas Medical Association House of Delegates no shortage of business to tend to Saturday when it comes to protecting and better positioning the profession of medicine.
Perennial issues like low Medicaid payments and health plan red tape required no debate at all. Delegates readily adopted the Socioeconomics Reference Committee’s recommendations that TMA:
- Advocate to increase Texas Medicaid physician payment rates to at least Medicare rates, because the COVID-19 pandemic “has made operating a physician practice financially impossible for many practices with a large Medicaid population.”
- Urge insurers to stop requiring physicians “to spend time – in addition to their extensive professional training – in training in each companies’ requirements for patient care”; urge the Texas Medical Board to condemn such health-plan practices as being beyond their purview; and urge both the Texas insurance commissioner and the Texas Legislature to take action on those health plan training requirements as well.
- Advocate for legislation requiring commercial insurance carrier coverage transparency, including requiring insurers to provide accurate information on patients’ cost-sharing liability; requiring them to respond to phone inquiries about the patient’s cost-sharing responsibility; and penalizing health plans when they don’t provide that information accurately or timely. (TMA is working toward more health plan transparency in the Texas Legislature with House Bill 4012, which would require insurers to provide itemized cost estimates to patients on certain services that require preauthorization.)
A push for TMA to help establish and fund a physician-led center for evaluating health care reform policy garnered some discussion with the House of Delegates voting to study the project in collaboration with other medical societies.
The center would maintain an online platform “to provide for balanced critique about general and specific policy proposals, health care reports, and national health care systems” with the goals of improving public health literacy and providing knowledge to evaluate proposed health care legislation. Delegates who supported the measure noted how other, nonphysician-led groups have dictated public opinion on health care issues.
“The big insurance companies have these heavily funded think tanks which, in the name of nonpartisan opinions and data surveys, transmit a whole lot of … misinformation to the public at large, and we physicians have been victims of these marketing strategies from the insurance companies,” added Carrollton anesthesiologist Bhaskar Padakandla, MD.
A closer look at employment contracts
In other economic matters, delegates after some debate stepped back from a proposal in the Reference Committee on Financial and Organizational Affairs for TMA to encourage physicians “to bring their concerns regarding decisions made by physicians working for insurance companies to the attention of the Texas Medical Board and Texas Department of Insurance,” and for TMA to aggregate the data. Delegates opted instead to refer the issue for more study.
After hearing testimony from young physicians, voting members did, however, agree to study the impact of noncompete agreements in physician employment contracts and report back at TexMed 2022.
Resident and Fellow Section member Theresa Phan, MD, of Houston said the resolution will go a long way to “help younger physicians make the right decisions when taking their first jobs.”
Without further discussion, delegates voted to adopt other recommendations from the Financial and Organization Affairs Reference Committee to have TMA:
- Study and report back on, and collaborate with the Texas Hospital Association on a draft recommendation for the composition of hospital ethics committees around the state; and
- Take steps to create an Independent Physician Section.