Page 17 - OctSam2019

CORPORATE
MEDICINE

medical acts to qualified individuals while the physician board of directors. The law Texas has evidenced the difficult balance
prohibiting the delegated individual from remains clear that a “health organization in determining when a corporate entity
representing to the public they are author- may not interfere with, control, or other- has overstepped into the practice of med-
ized to practice medicine. wise direct a physicians’ professional judg- icine. A recent court, citing to other Texas
ment in violation of the Act, board rules, cases regarding CPOM, noted the lack of
Section 164.052(a)(13) or any other provisions of law.” “a finite or mandatory list of factors to
Authorizes disciplinary action against any determine whether a certain agreement or
licensee for impersonation of a licensed Professional Associations (PA) arrangement contravenes the [Medical
practitioner or allowing another person to doctors of medicine, osteopaths, and Practice] Act.”
use their license to practice medicine. podiatrists may form and own a profes-
sional association. The practitioner’s au- Pressures on Traditional CPOM
Section 164.052(a)(17) thority is limited by the scope of their Restrictions
Provides for disciplinary action against a practice and a practitioner is prohibited The pressures on the CPOM in Texas are
practitioner that aides or abets, directly or from exercising control over the other’s no different from other states. Trends in
indirectly, the practice of medicine by a clinical authority in any manner that would private and payor reimbursement and a gen-
non-licensed individual. assert control over treatment decisions eral movement in policy towards value-
made by the practitioner. based reimbursement have put additional
Section 164.156 pressure on state legislatures to reduce bar-
Prohibits an individual, partnership, trust, Professional Limited Liability riers to clinical integration.
association or corporation to represent they Company (PLLC) This policy shift has led to a rare and en-
are entitled to practice medicine if they are A PllC may be comprised of both pro- dangered form of governing historically
not licensed to do so. fessional individuals and professional enti- known as “bipartisan” – the past three ad-
ties. The PllC must be organized for the ministrations in Washington have embraced
despite this broad prohibition, over time, purpose of performing a specific type of the movement away from fee-for-service
the Texas legislature has provided statutory professional service and ancillary services. and towards a system that rewards value.
exceptions to CPOM. However, while this A PllC may not provide more than one Starting with the George W. bush adminis-
could be interpreted as the erosion of kind of professional service. tration, the Centers for Medicare & Medi-
CPOM, in each instance the legislation or caid Services has moved towards increasing
implementing regulation makes clear that a legislative changes in 2011 also pro- reimbursement mechanisms based on
physician’s independent medical judgment vided for physicians and physician assis- value. The current administration has en-
may not be directed or controlled by a non- tants to form a corporation or partnership dorsed and expanded the movement-to-
physician. to perform a professional service that falls value implemented by the Obama adminis-
within the scope of their practice. Addi- tration through the Center for Medicare
Certified Non-Profit Health tionally, critical access hospitals, sole com- and Medicaid Innovation created under the
Corporations munity hospitals, federally qualified health Patient Protection and Affordable Care Act.
The non-profit health corporation must centers, and certain hospital districts are Secretary of Health and Human Services
be organized solely by licensed physicians. permitted to employ physicians. This ex- Alex Azar has made the movement to value
The directors of the corporation are re- panded upon prior exceptions for private, one of his top goals:
quired to be licensed physicians that are non-profit medical schools, school dis- “There is no turning back to an unsus-
actively engaged in the practice of medi- tricts, certain state institutions, and rural tainable system that pays for procedures
cine. The Corporation must be approved health clinics. rather than value. In fact, the only option
and certified by the Texas Medical board. It is also generally permissible for a is to charge forward – for HHS to take
Policies regarding credentialing; quality as- physician to enter into an independent bolder action, and for providers and pay-
surance; utilization review; and peer re- contractor relationship with a non-physi- ers to join with us. This administration
view policies must be made exclusively by cian entity. Judicial scrutiny of CPOM in and this President are not interested in in-
continued on page 18
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