patient choice include medication compliance, routine screening exams, weight management, and tobacco counseling.
Don’t tax sickness
Saving lives should not be taxed like other services. Health care is not a traditional business activity and should not be subject to a traditional business activity tax.
Recognizing the unique nature of health care, when legislators rewrote the state’s business tax in 2006, they included deductions for the free and under-reimbursed care physicians provide to Medicaid, Medicare, Children’s Health Insurance Program (CHIP), workers’ compensation, military, and charity care patients. Because physicians have contractual and ethical obligations to care for patients, often without regard to their own financial interests, their losses on unpaid and underpaid services are unavoidable and substantial. Those losses merit recognition.
No other profession is required by law to give away its products or services for free. Federal law requires physicians to provide care to patients in emergency settings without regard to ability to pay. Texas physicians deliver almost $2 billion per year in a hidden tax via unpaid charity care.59
Medicaid and CHIP payments to Texas physicians cover less than half the cost of providing care. Each Texas physician, on average, provides almost $83,000 per year in undercompensated care to Medicaid and CHIP patients (even more in some specialties) in rural Texas and along the border. Tax increases add to the cost of caring for these patients, forcing more physicians to find ways to limit participation in these government programs.
Current Texas tax policy imposes a tax on vaccines purchased for use in a physician’s office then administered through inoculations. For many physicians, vaccines are the second-largest expense for their practice, which can influence whether they continue to stock and offer vaccines. Because the cost savings from immunizations are
October 2012 TEXAS MEDICINE 61
considerable, Texas should promote greater access to immunizations by eliminating taxation barriers for physician practices.
Texas physicians pay their fair share in business and personal taxes. They also pay such additional state taxes as a licensing fee, an occupational tax, a patient-protection fee, a website fee, and an additional license surcharge imposed by the legislature. These fees are in addition to the sales taxes physicians pay on the supplies and equipment they use to care for patients, and the property taxes they pay on all business property and equipment.
A PHYSICIAN’S STORY
Juan Fitz, MD Lubbock
Regulations Are Driving Young Doctors Away
“The fear that I see is that a lot of our students are coming up and are not really getting to enjoy what it is really to be a true physician, a complete physician. The way the reimbursement situation is going on, unfortunately, it’s driving a lot of people away from medicine. Too much regulation. Too many things to account for are driving a lot of our bright students away from medicine.”
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68