have access to existing safe harbors under the Texas Advance Directives Act for resolving conflicts out of court without forc- ing them to violate their morals and professional ethics. The end-of-life effort was undertaken by one of several co- alitions TMA forged with influential state groups and lawmak- ers that led to compromise legislation this session and will continue to pay off in future discussions, Dr. Brotherton says. TMA Council on Legislation Chair Leslie Secrest, MD, adds
that more money in the budget also allowed lawmakers to focus attention on other issues that may at first seem small. The ability to get a CSR permit on time, swipe patients’
driver’s licenses for information, and cut down on hundreds of prior authorization forms “are things that seem really simple, but when you add them up, you’ve just saved the profession a whole bunch of time and cost that can be put back into the delivery system.”
Red tape reduced; “silent PPOs” silenced TMA’s red-tape reduction effort this session will help physician practices run more efficiently and regain valuable time and money spent away from patient care. (See “Small Problems, Big Impact,” December 2012 Texas Medicine, pages 41–46.) Some of the common-sense fixes, as described by TMA lead- ers, breezed through the legislature, while other bills, despite some hiccups along the way, passed the final week of session. Physician and first-time state Sen. Charles Schwertner, MD
(R-Georgetown), who supported TMA’s red-tape reduction and insurance transparency efforts, said those bills are “going to make the practice of medicine more efficient so physicians can focus on providing care to patients.” He sponsored Senate bills 1609 and 1610, which will
streamline the standards physician practices must follow in training staff on privacy laws and for notifying patients if their private information is breached. The bills, a collective effort between TMA and the Texas Medical Liability Trust (TMLT), refine and clarify a related law passed last session. They align state training requirements with federal rules and close loop- holes that threatened to subject physicians to multiple states’ privacy law standards. TMLT Executive Vice President of Governmental Relations
Jill McLain says House Bill 300 passed by the 2011 legislature has strong language to protect patients’ sensitive health infor- mation. But in preparing to train physicians on how to comply with it, TMLT and TMA discovered the law needed fine-tuning. “Physicians want to follow the law, but in such a way that
is reasonable and practical so that everybody achieves the in- tended goals,” she said.
Beginning Sept. 1, physicians and their staff also can check in patients using the electronic strip on the back of their Texas driver’s license, thanks to the governor’s early approval of Sen- ate Bill 166 by Sen. Robert Deuell, MD (R-Greenville), and Rep. Lyle Larson (R-San Antonio). Backlogs in processing applications to renew CSR permits at the Department of Public Safety (DPS) are likely a thing of the past, thanks to House Bill 1803 by Rep. Bill Callegari (R-Katy) and Sen. Joan Huffman (R-Houston). Effective Jan. 1, 2014,
renewal of the permits will become part of physicians’ biennial online medical license renewal at TMB. The DPS backlog was a nightmare for many physicians. One of them, Lubbock emergency physician Juan F. Fitz, MD, had his hospital privileges put on hold in March when DPS did not renew his registration on time, causing him to miss a shift. “If you don’t have your DPS license, you can’t work,” he said. Fortunately, another physician — on his day off — filled
in. But that’s not always the case in a rural area, and without access to emergency care, “it would have been a total disaster” for patients, said Dr. Fitz, past president of the Lubbock-Cros- by-Garza County Medical Society. Putting CSR renewals on the same cycle as the medical li-
cense renewals not only will help avoid such lapses, but also will save practices like Austin Regional Clinic (ARC) the cost of dedicating a full-time staff member to keep track of the documentation and staggered renewal deadlines for its 330 physicians, says ARC Founder and Chief Executive Officer Nor- man Chenven, MD. Physicians are “credentialed a thousand times over if they
are working in a hospital, and it’s all documented. So it just didn’t make sense to create an added administrative burden and hassle,” he said.
Physicians also can look forward to a day when they don’t have to deal with hundreds of different prior authorization forms from multiple payers. Senate bills 644 and 1216 require the Texas Department of Insurance (TDI) to appoint stake- holder workgroups to design standardized prior authorization forms for prescription drugs and health care services, respec- tively, for public and private payers. In testimony before the Senate State Affairs Committee, TMA showed that, on average, handling preauthorizations alone requires one full-time staff nurse to support every three physicians, in addition to the time spent by physicians and other staff.
Nor will physicians have to deal with surprise hassles when
third-party payers or other companies and secondary networks sell, lease, or share doctors’ privately contracted discounts without permission, thanks to new regulations on these silent PPOs.
Senate Bill 822 by Senator Schwertner and Rep. Craig Ei-
land (D-Galveston) establishes rules to identify these compa- nies, subjects them to TDI oversight, and regulates how they
Stephen L. Brotherton, MD
Leslie Secrest, MD
Sen. Charles Schwertner, MD
August 2013 TEXAS MEDICINE 23
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