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ELECTION
about the money,” it’s always about
the money. Chances of a fix in this
session: 0 percent.
• SCOPE OF PRACTICE THREATS:
The TMA has a strong track record of
beating back scope of practice en-
croachments from
other professions,
such as chiropractors published in the Nov. 17, 2016 issue of the New England Journal
wishing to do elec-
tromyography and nerve
conduction studies, or podiatrists wanting to operate above the
ankle. These are relatively easy to defeat. There is a more difficult
issue associated with “physician extenders” (PAs, APNs) who are ask-
ing for independent practice privileges, owing to the fact that other
states have already passed such legislation, and there has not been
an avalanche of standards of care problems. Texas is uniquely vul-
nerable to this threat because of geography, having a large rural pop-
ulation without access to primary care. There are 35 counties in
Texas without any doctor, and almost half the counties (125/254)
are federally designated “primary care shortage areas.” Chances of
our success in this session: 70 percent.
• “SURPRISE BILLING”:
This, of course, refers to the common occurrence of a hospital
being in an insurance plan’s network, but physicians contracted
to the hospital are not. This occurs most commonly in hospital
IMPACT
EDs, when a patient appears for care based upon the hospital’s
“in-network” status, not knowing that the ED physicians are “out-
of-network.” This results in the patient being billed for the bal-
ance between the physician’s charges and the insurance plan’s
payment to the physician, which may be nothing at all, depending
on the plan’s rules. These bills may range from a few hundreds to
several thousands of dollars. This is now a high profile issue with
considerable coverage from major news outlets (New York Times,
Wall Street Journal, NBC, etc.) after a study of this problem was
of Medicine. This investigation used data from a large insurer cov-
ering tens of millions of patients, and found that 22 percent of
all patients attending in-network hospital EDs received “surprise”
physician bills from out-of-network physicians in those EDs. In
Texas, hospitals in the network of the three largest insurers ranged
from 21 percent to 56 percent having no in-network ED physi-
cians. Although TMA has offered several approaches to alleviate
this situation, it is likely that there will be legislation unfavorable
to physicians offered regarding “surprise billing.”Chances of suc-
cess in this session: 50 percent.
As noted above TMA has a robust bill-tracking
system, which allows us to identify legislation as
it makes its way through the process, and we are
alerted to hearings at which we need to supply
physician testimony. Issues to be on the lookout
for include bills dealing with telemedicine, the
Texas Medical Board which is undergoing “sunset
review” this year, potential threats to our existing
tort reform protections, and funding for robust
public health measures, such as Zika, Ebola, and
other challenges.
Those of you interested in any of these
issues can access the TMA website
(www.texmed.org) for updates.
visit us at www.bcms.org 19