share a physician’s contract information, including obtaining doctors’ permission to do so. The law takes effect Sept. 1. Dr. Brotherton says these “silent PPO” practices mislead patients and cause needless, costly hassles for physicians, and the law will bring needed awareness and regulation of these activities.
“It was basically stealing,” he said. “Physicians negotiated specific rates with different vendors, and through convoluted pathways, those rates were getting passed on to companies that were not making the same concessions, so doctors were not getting a fair bargain.” Dr. Secrest likened silent PPO activities to “someone sub- leasing your apartment without you knowing about it,” adding that such practices also affect access to care. If payers can sell physicians’ network participation without their knowledge, physicians “may suddenly be responsible for thousands of patients arriving on your doorstep without being able to adjust your operations,” he said. “If that’s the way they are operating, how are [doctors] supposed to deliver good care without being properly staffed or without an awareness of who you are taking care of?” The bill also won support from Blue Cross and Blue Shield
of Texas. The plan’s chief medical officer and TMA board trust- ee Dan McCoy, MD, testified that “it makes sense that provid- ers should know who they are contracting with and what they are going to get paid.” Representative Eiland, who worked on the bill for the past
four sessions, said with the new legislation, “we will be able to know what groups are out there taking doctors’ discounts and where those discounts are coming from. Doctors will know exactly what the schedule for each line of business will be and who will have access to those discounts. It has been a long time coming, but I am happy to say that doctors will now have more transparency in their contracts. Transparency was a big theme this session, and I believe is one reason that this issue had more traction than in past sessions.”
Senator Schwertner echoed that theme saying, “This bill is about truth in contracting and shining a light on these silent PPO networks. It’s a great win for medicine to finally get this bill across the finish line,” which he described as a “battle to the end” against a potential veto threat.
TMA officials praised the bill author and sponsor for getting the legislation passed, but also said TMA will continue to work with TDI and newly appointed Insurance Commissioner Julia Rathgeber as the agency develops rules to ensure that health plans treat patients and physicians fairly and appropriately. Similarly, Senate Bill 1221 by Sen. Ken Paxton (R-McK- inney) ensures that physicians know when their discounted contract rates under Medicaid managed care or the Children’s Health Insurance Program (CHIP) are applied to commercial products.
Meanwhile, testimony by TMA physicians helped deter a swath of bills that would have required physicians to give pa- tients up-front binding quotes of the price of their care and subject them to both financial penalties and medical board sanctions for deviating from those quotes. TMA supports trans-
parency in health care pricing, but testified such approaches could be administratively burdensome, especially when it is impossible for physicians to predict all the medical services a patient may need, not only by that physician, but by others, as well.
Scope compromise wins the day This session also saw the usual flurry of scope-of-practice bills by allied health professionals looking to practice beyond their expertise. Chiropractors wanted to conduct mental and physical ex- aminations of school bus drivers. Physical therapists sought direct access to patients without a diagnosis. Pharmacists wanted to vaccinate children.
“It has been
a long time coming, but I am happy
to say that doctors will now have
more transparency in their contracts.”
Sen. Robert Deuell, MD
Norman Chenven, MD
Rep. Craig Eiland August 2013 TEXAS MEDICINE 25
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