UNDER THE ROTUNDA
The House of Medicine brought one strong reason after another to Tuesday’s House Insurance Committee hearing on why lawmakers should support a measure that takes two major steps to reduce physicians’ prior authorization burden.
Little Elm internist John Flores, MD; Houston internist Lisa Ehrlich, MD; and San Antonio radiologist Ezequiel “Zeke” Silva, MD, were at the Capitol to testify for the Texas Medical Association in support of House Bill 3459 by Rep. Greg Bonnen, MD. Under the bill, health plans would be required to grant “gold card” status to physicians who perform a procedure at least five times a year with a prior authorization approval rate of at least 80%. That status means physicians would be exempt from prior authorizations for that procedure for the year that follows.
HB 3459 also would require peer-to-peer calls in utilization reviews to be conducted by a physician in the same or similar specialty as the treating physician – addressing treating physicians’ long-standing complaints that peer-to-peer calls often aren’t with a “peer” at all.
HB 3459 is important because it eliminates delays to patient care and removes waste and administrative burdens that physician practices endure for preauthorizations, Dr. Silva said in prepared testimony.
Medicine’s three representatives collectively came to the committee armed with several points in support of HB 3459. Among them:
- In a TMA Survey of Texas Physicians, 78% of respondents said prior authorizations have led to patient abandonment of care, and 38% said preauthorizations have affected care delivery and led to a serious adverse event.
- In a nationwide American Medical Association survey released last week, 94% of physicians saw delays in care as a result of prior authorizations, 79% reported preauthorization sometimes leading to total abandonment of care, and 18% say preauthorization has led to a life-threatening event or required intervention to prevent permanent damage or impairment.
“Working with my patients every day, I find the use of prior authorizations by health plans to be anything but good for the patient,” Dr. Ehrlich said in a prepared statement.
TMA also had witnesses lined up in House Insurance on Tuesday in support of:
- House Bill 2035 by Rep. Julie Johnson (D-Farmers Branch), which seeks to reinforce the prudent layperson standard in emergency care. It would require utilization review on emergency care to be performed by a Texas-licensed physician who is board certified in emergency medicine and would prohibit a utilization review physician from denying the claim based on the final diagnosis. TMA President Diana Fite, MD, was scheduled to represent medicine.
- House Bill 2668 by Rep. Four Price (R-Amarillo) to outlaw copay accumulator programs in prescription drug purchases, in which insurers don’t allow patients to count manufacturers’ coupons toward their deductible and out-of-pocket maximum, increasing costs to the patient. Dr. Flores was scheduled to testify.
- House Bill 980 by Rep. Arthur Fierro (D-El Paso), to require health plans to implement payment parity for telemedicine. TMA’s scheduled witnesses were Austin family physician Jacob Childers, MD, and Austin psychiatrist Thomas Kim, MD.
Breast cancer screening coverage
Austin radiologist Sarah Avery, MD, represented TMA on Tuesday morning in its push for crucial insurance coverage for diagnostic breast cancer screening.
Dr. Avery testified in the Senate Business and Commerce Committee in support of Senate Bill 1065 by Sen. Carol Alvarado (D-Houston), which would expand the types of diagnostic mammography services certain health plans are already required to cover, and require plans covering diagnostic imaging to provide at least the same cost-sharing as coverage for a screening mammogram. Also, SB 1065 would include patients with a history of dense breast tissue as among those eligible for diagnostic imaging.
Senate budget bill leaves committee
The House Appropriations Committee on Monday gave its signoff to the Senate’s current draft of the budget bill. Senate Bill 1 – which as drafted would adequately fund graduate medical education, a huge would-be win for medicine – now is on its way for consideration by the full House after previously passing the Senate on April 6. It’s expected that SB 1 will be on the House floor on April 22.
Once both the House and Senate versions of the budget are passed, a conference committee must reconcile the two versions into one budget for 2022-23.
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