TMA Calls on Governor to Loosen Surgery Restrictions, Help Struggling Practices
By David Doolittle

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Texas Gov. Greg Abbott should support Texas physicians by relaxing restrictions on non-urgent surgeries and providing payment relief for Medicaid, the Children’s Health Insurance Program (CHIP), and state-regulated health plans, the Texas Medical Association says.

Under an executive order signed in March, all non-urgent surgeries and medical procedures “that are not immediately necessary” have been postponed until April 21 to conserve hospital capacity and critical resources during the COVID-19 emergency. Governor Abbott is expected to extend that order, though he has not done so. 

In a letter to Governor Abbott signed April 13, TMA President David C. Fleeger, MD, proposed amendments to the order that “address concerns from physicians and facilities asking for guidance to determine which surgical and procedural services can be safely postponed and those that should proceed to prevent harm to patients.” 

The proposed additional language would allow licensed health care professionals to refer to relevant information – such as guidelines or literature from organizations like the Centers for Disease Control and Prevention, Centers for Medicare & Medicaid Services, or other nationally-recognized medical or specialty entities – when determining what surgeries or procedures to postpone. 

TMA also asked the governor to remove language that exposes physicians who violate terms of the executive order to criminal prosecution and a fine of up to $1,000 and/or a jail term of up to 180 days. 

“TMA is concerned that the additional threat of criminal sanctions may have a chilling effect on patient care, risking serious harm by potentially deterring their physicians from providing critical care,” Dr. Fleeger wrote. 

In a separate letter, TMA and 30 state medical societies and organizations called on Governor Abbott to implement a multi-point plan to promote accountable care and to help physician practices who are struggling financially because of restrictions in place, particularly physicians who care for pregnant women, children, seniors, and people with disabilities. 

Details of the plan include:

  • Directing Medicaid, the Employee Retirement System (ERS), and the Teachers’ Retirement System (TRS) to swiftly implement advanced payment models akin to Medicare’s;
  • Directing Medicaid and state-regulated health care plans to suspend prior authorization requirements throughout the emergency and to authorize use of telemedicine for well-child visits temporarily;
  • Suspending reporting related to performance or quality metrics and eliminating state or plan-specific penalties for failure to meet performance targets, including down-side risk; and
  • Suspending medical record audits or other record requests. 

In addition, the plan calls for Texas to:

  • Advocate strongly for federal funding to boost Medicaid physician payment rates to Medicare parity;
  • Suspend medical and prescription drug prior authorizations for most Medicaid fee-for-service and managed care services, and to suspend all Medicaid required audits except for those related to fraud or abuse;
  • Temporarily cease physician and provider revalidation until the end of the emergency period; and
  • Recognize alternative medical care facilities and COVID-19 testing sites (such as mobile units) as temporary payable places of service for physicians and health care professionals in order to ensure they get paid for their services. 

Medicine’s letter also says the Texas Department of Insurance should strongly encourage health insurers that administer self-insured products to remove barriers that interfere with an estimated 9 million Texans with employer-sponsored health insurance obtaining timely access to COVID-19 related treatment, including expanding availability of telemedicine services and removing cost-sharing. 

“Over the past six weeks, physicians have worked fast and furiously to redesign their practices to abide by state and national best practices regarding safe, timely patient care during a pandemic,” the letter says. “We ask that you help Texas physicians keep their doors open so they can continue to deliver the excellent medical care all patients in Texas deserve.” 

You can find the latest news, resources, and government guidance on the coronavirus outbreak by visiting TMA’s COVID-19 Resource Center regularly.

 

 

Last Updated On

April 14, 2020

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David Doolittle

Editor

(512) 370-1385

Dave Doolittle is editor of Texas Medicine and Texas Medicine Today. Dave grew up in Austin, where he attended culinary school as well as the University of Texas. He spent years covering Central Texas for the Austin American-Statesman newspaper. He is the father of two girls, a proud Longhorn, and an avid motorsports fan.

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