Specialties List Scope, Balance Billing Among Top Targets for 2019
By Joey Berlin

2018AdvocacyRetreat_Specialty Initiatives

“Remember the old saying: If we’re not at the table, we’re on the menu.”

That was the warning C.M. Schade, MD, past president of the Texas Pain Society, delivered as he finished listing the society’s priorities for the 2019 Texas Legislature during the Texas Medical Association’s annual Advocacy Retreat on Saturday morning at the Renaissance Austin.

Representatives of more than 20 specialty societies ran through each organization’s top legislative priorities. Not only will they be at the table, they’ll be hungry. And they’ll be clamoring for a lot of the same food, sharing common interests in what the legislature should do beginning in January.

While many of the specialties are focusing on topics unique to their practice, several of the House of Medicine’s biggest and most perpetual global challenges came up again and again. Saturday among the most-cited topics:

Scope of practice — Many of the societies cited the never-ending fight to keep the practice of medicine, and the safety of their patients, in the hands of trained physicians.

“If you look around us, you look at Louisiana, you look at Oklahoma, they have privileges to do things that should not be done by nonphysicians. So when people talk about a border wall … I’m 100 percent for it. There needs to be some barrier between Texas and Louisiana to protect Texas patients,” joked Sanjiv Kumar, MD, president of the Texas Ophthalmological Association.

He added that the association is looking “just to preserve surgery by surgeons, medical prescription drugs [prescribed] by physicians — basic scope issues that all of us have in common. If there is any significant battle, we plan to be out there at the tip of the spear to try to kill these things.”

Balance billing and network adequacy — Balance billing and making sure insurance providers maintain adequate networks came up repeatedly, just as they did in 2017.

“Networks have to be adequate,” said Tilden Childs, MD, legislative chair for the Texas Radiological Society. “We can’t be having large numbers of physicians out of network, as was recently attempted in anesthesiology, and expect physicians to take substandard low wages for being at the mercy of the insurance companies.”

Balance billing — and preserving a physician’s right to be paid for medical care provided — are also on the agenda of the Texas Neurological Society (TNS).

“We should be transparent with our patients, but we think we should be compensated as well in being able to bill for the services that are provided and receive payment for those services,” said Houston neurologist Eddie Patton, MD, a board member at large for TNS.

Opioids — Several societies trained their sights on administrative burdens coming into vogue as part of the effort to attack opioid addiction and illicit prescribing.

Temple internal medicine physician A. Jimmy Widmer, MD, representing the Texas chapter of the American College of Physicians, said internists want to work with emergency physicians and surgeons to “make sure that we are able to prescribe the medications to patients that we see fit, and not deal with the onerous and burdensome red tape that takes away from our time to take care of our patients and interact with our patients.”

The looming mandate to check the state’s prescription monitoring program before issuing a prescription for any of four different drug classes, including opioids, factors into plenty of societies’ legislative plans. The Texas College of Emergency Physicians (TCEP) wants to see emergency medicine exempted from the mandate, which takes effect Sept. 1, 2019.

“If somebody has a broken leg, they should be able to get the prescription that they need without us having to check the database,” said TCEP President Heidi Knowles, MD.

Texas Urological Society (TUS) President Mark Sutton, MD, also advocated for an exemption for post-operative opioid care.

Prior authorization — TUS was one of several groups calling for legislation to combat insurers’ prior authorization requirements and what Dr. Sutton called “peer-to-peer abuse” — the conversations with other medical professionals to justify for an insurer the necessity of a treatment.

Lilly Timon, chair of the legislative committee for the Texas Medical Group Management Association, said members across the state had noticed a huge increase in prior authorization requirements for medications this year. And peer-to-peer requirements for testing were increasing for 2019, she said.

“We feel your pain,” Ms. Timon said, “and we are certainly here to support you.”


Last Updated On

December 04, 2018

Originally Published On

December 04, 2018