TMA Forges New Policies on Same-Day Services, Patient Attribution in Value-Based Care
By Phil West

Reflecting physicians’ ongoing frustrations with certain health plan practices and aspects of value-based care, the Texas Medical Association House of Delegates called for greater accountability and transparency from payers at its 2025 TexMed session on May 10.   

With health plans increasingly adopting payment protocols that hinder physicians from providing multiple services on the same day – despite previously covering such services – delegates adopted policy calling on TMA to “advocate for legislation or regulation that would prevent Medicaid and commercial payers from denying payment for distinct, separate services provided on the same day.”   

Delegates agreed with physicians’ concerns that these payer practices often force patients to forego care.   

“This especially hurts patients who either have to travel long distances to see their physician or have transportation issues that prevent them from making multiple trips,” Odessa allergist and immunologist Vivek Rao, MD, wrote in online testimony on behalf of the Lone Star Caucus.   

Other measures adopted by the house to eliminate payment-related barriers to patient care direct TMA to pursue state-level legislation or regulation that:  

• Prohibits insurers, plan sponsors, third party administrators, and other contracted identities from recouping previously paid claims due to retroactive termination of patient coverage;  

• Imposes payer communication standards – with penalties – that provide patients, physicians, and others with timely access to a live representative; and 

• Expedites prior authorization approvals for hospice care in emergency and acute care settings, eliminates deductibles for hospice care, and provides clear disclosures detailing hospice care benefits in policy documents as well as online. 

A resolution calling for efforts to increase oversight of private equity in health care that drew debate was referred for study by the House. 

Improving patient attribution

Meanwhile, physicians utilizing value-based care delivery models who are wrestling with patient attribution issues received new TMA policy support brought forth by the Committee on Alternative Payment Models. 

“Currently there is no universally agreed upon standard for payer attribution methods,” the committee noted in its report, citing a National Quality Forum study showing “more than 170 different attribution models have been developed in the last two decades.”   

This source of physician frustration has led to a host of attendant issues, including transparency, consistency, and accountability related to the variability of attribution methodologies; errors impacting or delaying payment; and auto-assignment and misattribution when a patient-physician relationship has not been clearly documented.  

“Patient attribution [is] a major concern among family medicine physicians,” said Triwanna Fisher-Wikoff, MD, in online testimony on behalf of the Texas Academy of Family Physicians’ Council on Medical Practice. “Incorrect patient attribution has created a cumbersome burden on our physicians and staff. …  Since we have no real control over these patients and their health care, we cannot guarantee they are getting the quality care needing for healthy outcomes as well as to meet the [payer] metrics.” 

To help remedy that, the house approved new TMA policy calling on the association to advocate for legislation and regulation requiring:  

• Payer transparency for patient attribution methods deviating from generally accepted standards;  

• Attribution reports to be accessible and regularly updated attribution reports; 

• Formal, transparent, and efficient mechanisms that enable physicians to verify and correct patient attribution data, with processes for dispute resolution and reconciliation of errors;  

• Patients’ voluntary selection of clinician where appropriate; and 

• Strategies that ensure attribution is assigned to the physician most responsible for managing a patient’s care. 

Review existing TMA policies in a reference guide searchable by topic, and learn more about shaping future TMA policy.