TMA, Lawmakers Working to Tackle Telemedicine Parity, Prior Authorization
By Joey Berlin

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As one of the most unique eras of both living and lawmaking continues, attendees at TMA’s Winter Conference heard about medicine’s legislative agenda in both Austin and Washington, D.C., and how COVID-19 has helped shape this year’s legislative focus.

TMA President Diana Fite, MD, led a panel Saturday of three other physicians and one legislator in the state and federal crucibles: Austin oncologist Debra Patt, MD, chair of TMA’s Council on Legislation; Fort Worth allergist Susan R. Bailey, MD, president of the American Medical Association (AMA); Houston plastic surgeon Russ Kridel, MD, chair of the AMA Board of Trustees; and state Sen. Lois Kolkhorst (R-Brenham), chair of the Texas Senate Committee on Health & Human Services.

The Winter Conference also included a discussion by two top state health officials on Texas’ COVID-19 vaccination efforts.   

State legislative priorities

Drs. Fite and Patt outlined TMA’s priorities at the state level, which include expanding health coverage to address the problem of the state’s uninsured and underinsured; reducing the impact and red tape of prior authorization; improving patient access to care through further advancement of telemedicine; and avoiding a now-delayed tax on medical billing companies, which would inevitably result in costs passed onto physicians. 

While telemedicine made “leaps and bounds” during COVID, and has been found to be very advantageous for many disabled and elderly patients, it’s “hard to arrange in some rural areas where they don’t have access,” Dr. Fite noted. “We did get approval in some places for telephonic-only (telemedicine visits), because some people are not set up to be able to do visual as well. But we need to have telemedicine to remain at parity for full clinic visits as well for payment purposes, and including after the pandemic is over.”

Stressing the burdens of prior authorization – and the fact a lot of those hassles increased during the pandemic – Dr. Patt listed several of medicine’s proposals for addressing that problem, including:

  • Reducing red tape, such as by requiring state-regulated health plans to “gold-card” certain physicians out of the prior-auth process;
  • Requiring insurers to make staff available around the clock and on weekends to process pre-approval requests ; and
  • Reforming peer-to-peer calls so physicians who must make them are talking to an actual “peer” who knows something about their specialty.

Senator Kolkhorst ran through some of what’s in the Senate’s base budget proposal, Senate Bill 1, and also discussed the importance of giving physicians full, lawful practice autonomy while stopping scope-of-practice infringements by nonmedical professionals.

“There’s some really good news in health care. But … our focus has to be on post-pandemic recovery, lessons learned making sure that we have protection for you doctors who have given us so much over the last 11 months, and making sure, too, that you get to practice at the top of your credentials, while making sure that others don’t try to creep into that and we see a dip in what we think is quality health care,” she said.

Dr. Patt emphasized to attendees that during the current session of the Texas Legislature, “what we need is you [physicians] to be active in your constituency and make sure that you’re reaching out to important leaders like Senator Kolkhorst and others.”   

The national picture

Laying out some of the landscape at the national level, Dr. Bailey said AMA’s federal priorities include the recent surprise-billing restrictions passed by Congress that will take effect in 2022, and pushing back against scope-of-practice reaches by nonmedical professionals. 

Dr. Bailey said AMA will be deeply engaged in the regulatory process on the new surprise-billing law. In several states, she said, legislators “have adopted the health insurers’ messaging” and used surprise billing legislation as a way to “broadly reduce” physician payments.

“The AMA will continue to fight these efforts, and we will look to Texas for help as that comes about,” she said.

And now that vaccinations for COVID-19 are available, Dr. Kridel said medicine can press ahead on other issues that are plaguing physicians, including eliminating caps on Medicare payments.

“Through our arcane payment system – and it’s nothing else but that – physicians are singled out and paid differently than hospitals, nursing homes among other facilities, and the pharmaceutical industry, which all get cost-of-living … increases yearly,” he said. “It just has to stop, and we need to demand change.”

Easy Ways to Get Involved in TMA Advocacy   

The 2021 legislative session brings new opportunities to get involved in TMA’s grassroots advocacy efforts at the Capitol.

Your participation is a vital component of our legislative success. Please help strengthen the voice of medicine by joining our advocacy efforts.

Stay up to date on TMA’s progress in the legislature. And take advantage of other opportunities to get involved with our advocacy efforts.

Last Updated On

February 01, 2021

Originally Published On

February 01, 2021

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Joey Berlin

Associate Editor

(512) 370-1393
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Joey Berlin is associate editor of Texas Medicine. His previous work includes stints as a reporter and editor for various newspapers and publishing companies, and he’s covered everything from hard news to sports to workers’ compensation. Joey grew up in the Kansas City area and attended the University of Kansas. He lives in Austin.

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