sight in an employed arrangement is a vitally important com- ponent of SB 894, Dr. Borgstedte says. “As chief medical officer, I serve as a buffer between the hospital and the employed physicians. Without the clinical au- tonomy and medical staff oversight protections in the law, in some instances, physicians wouldn’t be heard, and hospital administrators would call the shots,” he said. Douglas Curran, MD, an Athens family physician and
member of the TMA Board of Trustees, testified on be- half of TMA for SB 894. He explained to Senate State Affairs Committee members that the bill would create a shared responsibility be- tween the physicians on the medical staffs of small hospitals and the hospitals’ administration and board of trustees. “We hope that with a structured set of provisions that place the governance of the hospitals’ clinical re- sponsibilities in the hands of the medical staff, we have protected the patient-phy- sician relationship and the ability of physicians — em- ployed or independent — to exercise their medical judg- ment for the benefit of their patients,” he testified. Dr. Curran stressed in his testimony that TMA viewed SB 894 as a solution for rural communities, giving them an op- portunity to level the playing field against their urban and suburban counterparts in recruiting physicians. SB 894 also requires the hospital’s chief medical officer to
the board’s purview, we’d refer it to the appropriate agency,” she said. Mr. Kreager says passage of SB 894 is significant for rural
Texas communities. “I think it was a tremendous win for the rural areas. The
“I think we’ll continue to see more physicians starting out as employees before transitioning into independent practice. For rural communities, hospital employment helps take the risk out of hanging out your own shingle.”
Looking forward
report to the Texas Medical Board (TMB) any instance of ad- ministrative interference in clinical or patient care decision making.
Thus far, Dr. Borgstedte has not received any complaints
from physicians about hospital interference in clinical decision making.
TMB Executive Director Mari Robinson says the board hasn’t
received any reports of compromised independent medical judgment at hospitals that are employing physicians. Should the board receive such a report, Ms. Robinson says it would look into the circumstances involved to determine which agen- cy should handle it. “If the report involves medical practice without a license, the board could issue a cease-and-desist order. If the violation involves an NPHC that was established, organized, or oper- ated in violation of the Medical Practice Act, the board could refuse to certify the entity, revoke the organization’s certifica- tion, or levy a monetary penalty. If the violation falls outside
TMA will pay close attention to hospitals’ and other entities’ ef- forts to expand the corporate practice of medicine this session. Mr. McBeath says TORCH doesn’t have any plans to introduce legislation on physician employment. He says two or three individual member hospitals likely will introduce their own legislation that would allow them to employ physicians. “We have a situation where a couple of hospitals feel dis-
criminated against by SB 894 because they ultimately didn’t qualify under the legislation’s provisions. After the 2010 Cen- sus figures came out, their populations were more than 50,000, and they were no longer eligible to employ under the bill.” Mr. McBeath said. According to TMB, five hospital chief medical officers reg-
istered with the board as required by SB 894, and their institu- tions currently employ physicians. Mr. McBeath says about 160 hospitals are eligible to take advantage of physician employ- ment under the legislation. Austin attorney Kevin Reed represents TORCH. He says some TORCH member institutions have indicated the cost to
February 2013 TEXAS MEDICINE 19
law recognizes changing physician demographics. Doctors are leaving training and aren’t willing to take on the risks of rural community practice, which consists of large populations of un- insured patients and those on Medicare and Medicaid. The legislation helps rural hospitals compete for physi- cians,” Mr. Kreager said. Senate Bill 1661 by Sena- tor Duncan and Rep. Todd Hunter (R-Corpus Christi) provides protections for phy- sicians employed by NPHCs certified by TMB. The bill makes the physician board of directors responsible for all clinical matters within these organizations. The bill prohibits a health
organization from disciplin- ing a physician for reason- ably advocating for patient care and prohibits the re- quirements of the bill from being voided or waived by contract. The bill authorizes a member of a health orga- nization to establish ethical
and religious directives and authorizes a physician to contrac- tually agree to comply with those directives.
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