cerns by prohibiting contractual confi- dentiality clauses on pricing information. Lawmakers also could enact measures
“to standardize the pricing structure, but not the price” for health care services “to make price comparisons possible for consumers,” he says. For example, phy- sicians, hospitals and other health care facilities could post a so-called reference price for a particular service, akin to what Medicare uses. Giving patients estimates of their costs doesn’t go far enough, and until patients can comparison shop on health care prices, physicians and hospitals are “under little or no competitive pressure to compete by lowering prices,” Mr. Luke wrote.
In fact, Dr. Carter pointed to FTC re-
search showing price disclosures could drive costs up, rather than down. As for a standardized pricing struc-
ture, “we already have an example of that. It’s Medicare. And it’s not a system
that has been very open to innovation or successful in controlling health care costs,” he said. “There is a fixed refer- ence price. Doctors take it, and patients know what they are going to pay. But there is no incentive to provide better services in a more efficient way because doctors are not going to get paid for it.” Moving in that direction would un- dermine the very kind of innovation Texas is looking to implement through the institute and other health care re- form efforts, TMA leaders say. Mandating that physicians post a single price and adhere to it would all but kill the risk-sharing arrangement Dr. Carter’s clinic has with payers, who give him a monthly fee for taking care of a patient as a way of incentivizing more efficient care. Experiments with shared savings programs, medical homes, and bundled payments for joint physician- hospital services — all models that allow payers to negotiate financial rewards in
exchange for quality and cost improve- ments — would not be possible. “It goes against everything we are try- ing to do in terms of value-based pay- ments and all of the other innovations we are looking at to refine the system,” Dr. Strate said.
State paying dual- eligibles’ Medicare deductible
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The Texas Health and Human Services Commission (HHSC) restored the Medi- care Part B deductible payment on Jan. 25 for patients eligible for both Medicare and Medicaid, known as “dual eligibles.” From Jan. 25 on, the Texas Medicaid & Healthcare Partnership (TMHP), the Medicaid fee-for-service claims payer, is paying the full deductible amount owed. TMHP will automatically process claims filed before Jan. 25 back to Jan. 1. In 2011, the legislature ordered HHSC to cut dual-eligible payments to save money. The two-part reduction eliminated Medicaid’s full payment of the annual deductible, which totals $147 in 2013, and stopped payment of dual- eligible patients’ coinsurance if the Medi- care payment for a service exceeded the Medicaid allowable, which is almost al- ways the case for physician services. To- gether, the new policy resulted in more than a 20-percent payment reduction for physicians who care for these patients. The restoration of the deductible comes none too soon. For the past year, the cut has wreaked financial havoc on physicians who care for this popula- tion, forcing a growing number of them to lay off staff, curtail services, or take out personal loans rather than stop see- ing these patients. Unfortunately, many were forced to limit the number of dual- eligible patients they will accept or even drop out of Medicaid. Physicians hardest hit were those who see large percentages of dual-eligible patients, many of whom are the poorest and sickest in Texas. The Texas Medical Association orga-
38 TEXAS MEDICINE March 2013
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