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“WE’VE REACHED NOW A BOTTOM LINE WHERE IF WE CAN’T OFFER DOCTORS ENOUGH MONEY TO PAY FOR THEIR OVERHEAD, WHY WOULD THEY WANT TO TAKE A RISK WITH THE OIG, OR TAKE COMPLICATED DUALLY ELIGIBLE PATIENTS THAT TAKE TWICE AS MUCH TIME AS STANDARD PATIENTS FOR HALF THE PAYMENT?”


seen fit not to address them. We’ve reached now a bottom line where if we can’t offer doctors enough money to pay for their overhead, why would they want to take a risk with the OIG, or take complicated dually eligible patients who take twice as much time as standard patients for half the payment?” The San Antonio internist and critical care pulmonologist added that participation issues also plagued the Medicaid Women’s Health Program (WHP), particularly after the 2011 legislature voted to exclude “abortion affiliates.” Planned Parenthood sued, and the federal government an- nounced federal funding would end Dec. 31 unless the state revokes the law. Texas Gov. Rick Perry subsequently vowed to continue the program with state-only dollars. At press time, the issue of whether Planned Parenthood could participate re- mained in litigation. Senator Nelson said there is enough state money to run the


program without federal support, “although we need to re- think our approach to ensuring that low-income women have access to preventive care. The federal government’s actions on this issue have been disappointing.” At the TMA Fall Conference, the TMA Board of Trustees voted to join the Women’s Healthcare Coalition, a statewide consortium of health care organizations and physician prac- tices advocating for the continued viability of WHP. WHP provides preventive screenings and contraceptives to low-income women who are not pregnant, as well as restora- tion of funding cuts to family planning programs administered by the Department of State Health Services (DSHS). TMA praised as a good first step HHSC’s decision to rescind a so-called “gag order” that prohibited physicians participating in WHP from even discussing abortion with patients, whether or not it was relevant to their care needs. But Mr. Whitehurst says the back-and-forth is just “another


22 TEXAS MEDICINE January 2013


example of the kind of issues that go into physicians’ consid- eration of whether to participate in programs like WHP and Med- icaid. Hopefully, we can get law- makers to take a step back and ask whether they really want to get in the middle of the patient- physician relationship.”


CUTTING THE RED TAPE


Meanwhile, the TMA advocacy staff is working to cure other bu- reaucracies plaguing physician practices through an omnibus


“red-tape reduction bill” directed largely at the Department of Public Safety (DPS). (See “Small Problems, Big Impact,” Decem- ber 2012 Texas Medicine, pages 41–44.)


The legislation would correct


inefficiencies in processing state permits to prescribe con- trolled substances by moving the process online and making the renewal concurrent with medical license renewals. The bill also aims to ensure that the new DPS online prescription drug-monitoring database remains a secure and user-friendly tool for doctors and does not become an unfunded mandate. New leadership at the Texas Department of Insurance (TDI)


also could influence TMA’s legislative and regulatory strategy when it comes to protecting doctors from health insurance plan gimmicks. In August 2012, Commissioner Eleanor Kitzman was criti- cized for pulling rules that required insurers to maintain ad- equate physician and hospital networks and to disclose to pa- tients their out-of-network obligations.


The move undid four years of work involving input from physicians, hospitals, health plans, and consumer groups that culminated in a set of agreed-upon rules former TDI Commis- sioner Mike Geeslin adopted in 2011. It also calls into question other established insurance regulations and protections TMA has won over the years, Mr. Whitehurst says. Ms. Kitzman’s “responsibility and job and focus should be on the consumer, and what’s in the best interest of the people purchasing these products to make sure they are getting some- thing of value,” Mr. Whitehurst said. Instead, “she has appar- ently chosen to look out for the individual interests of health insurance companies.” If that doesn’t change, “it probably adds to our legislative


agenda because we have no expectation of getting things through on the regulatory side,” added Dan Finch, TMA direc- tor of legislative affairs. At press time, newly proposed rules remained open to pub- lic comment. TMA advocated for a return to the originally ad- opted rules at a Nov. 14 hearing.


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