audit criteria, to following health plan regulations for recouping payments, “it is seemingly impossible for Texas prac- tices to comply” with the ever-increasing red tape and to manage the costs associ- ated with it, said Texas Medical Group Management Association President Pam Potter. She added that new antifraud rules
promulgated by the Texas Health and Human Services Commission are un- clear on what constitutes intentional versus unintentional mistakes, “making for a very scary proposition for physician practices.”
As for GME funding, Beaumont ortho-
pedist David D. Teuscher, MD, a member of the Texas Higher Education Coordi- nating Board (THECB), reassured physi- cians that “help is on the way.” He said restoring GME funding is “a top priority” for the board, which is ask- ing lawmakers for a $10 million increase in funding for the Family Practice Resi- dency Program and another $4.7 million for the Physician Education Loan Repay- ment Program, among other restorations to major cuts made last session. David W. Gardner, THECB deputy commissioner for academic planning and policy, also told physicians that the board will continue to advocate for a 1:1 ratio of GME residency training slots to medical graduates, and it has requested $11.5 million for that purpose. “We have made clear to [lawmakers] that this is the board’s minimum recom- mendation,” he said.
Ensuring health plans maintain ad- equate networks and protecting physi- cians’ right to bill for out-of-network services they provide were key goals for a host of medical specialty societ- ies, including those of anesthesiologists, emergency physicians, pathologists, and radiologists.
Dallas pathologist A. Joe Saad, MD, said he was “alarmed” by Texas Depart- ment of Insurance (TDI) Commissioner Eleanor Kitzman’s decision to rescind previously adopted rules that required insurers to maintain adequate physician and hospital networks and to disclose to patients their out-of-network obligations. TMA strongly supported those rules. Austin gastroenterologist Bruce A.
Levy, MD, who has participated in TDI workgroups over the years, said a com- mittee of payers, providers, consumers, and former TDI leaders “did reach a con- sensus” on the original regulations after 18 months of discussions, despite the newly appointed commissioner’s state- ment to the contrary. Undoing these negotiations could “chill the desire” of stakeholders to put in the same hard work in the future, he added. Ms. Kitzman said the department decided to redraft the rules because it “needed additional guidance from the legislature” to address “inconsistencies” in various state laws governing exclusive provider networks. She said some provisions in the earli- er rules created “an unlevel playing field between various entities,” but the recent version “comes as close to holding a pa- tient harmless as possible” when health plans do not have a complete network. “That’s my goal.”
TMA opposed the latest draft of the new regulations. The Division of Workers’ Compen-
sation, meanwhile, has undergone so many reforms over the years, “it’s time to take a breath and see if they are work- ing,” Commissioner Ron Bordelon said.
The division continues to move for-
ward this year with one of those reforms, a closed drug formulary, which the leg- islature continues to look at as a cost- saver and a way to reduce prescription drug overuse and abuse (see “Closed Formulary, Part Two,” pages 41–43). “It doesn’t look like it’s going to be a bad budget year for small state agen- cies,” Texas Medical Board (TMB) Execu- tive Director Mary Robinson said. However, less than half of the rev- enue TMB brings in from things like physician licensing fees stays within the agency. With record numbers of physi- cian license applicants coming in and limited staff and resources, the medical board is considering asking the legisla- ture to allow the agency to fund itself independently from the state budgeting process. The move could result in higher li- censing fees. n
Amy Lynn Sorrel is an associate editor of Texas Medicine. You can reach her by telephone at (800) 880-1300, ext. 1392, or (512) 370-1392; by fax at (512) 370-1629; or by email at
amy.sorrel@
texmed.org.
Texas Medical Board Executive Director Mari Robinson, left, spoke during the TMA 2012 Advocacy Retreat about the challenges facing state agencies during the 83rd Texas legislative session that will impact physicians.
February 2013 TEXAS MEDICINE 39
JIM LINCOLN
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