cians’ services — even if he could predict what his patients need.
He also warns against past proposals in the legislature and from IHCQE that would have required physicians to stick to their price estimates or face potential penalties, posing additional pitfalls for physicians and their ability to deliver the care their patients need. And even if physicians could come up with a simple “price tag” that ac- counts for all of the other variables, it still wouldn’t give patients what they are looking for, Dr. Carter says. “Most pa- tients only really care about what they are going to pay out of pocket, and that’s very much dependent on health plans and employers, not physicians.”
Enhancing transparency TMA leaders also pointed to existing leg- islative mandates that require physicians, hospitals, and health plans in Texas to help patients with cost estimates. And nothing prevents doctors from discuss- ing their billed charges or other esti- mates and discounts with their patients now, Dr. Carter says. In fact, TMA surveys show that even though physicians do not generally pub- lish their charges, they routinely give patients individual fees or cost ranges when they ask, try to estimate insurance payments in advance, and provide fee information when planning future tests or procedures.
The 2014 legislative interim charges
also ask the Senate State Affairs Com- mittee to study the impact of an exist- ing, comprehensive transparency law “and make recommendations regarding potential changes designed to create a more open marketplace for enhanced consumer decisionmaking in Texas.” The Texas Legislature passed Senate Bill 1731 in 2007 as part of an effort to protect patients from surprise, out-of- network bills. The state phased in the law’s implementation, which, among other things, requires:
• Insurers to give their members, upon request, an estimate of payments the plan will make, as well as any deduct- ibles, copayments, or other amounts the patient is responsible for;
Medicare discloses physician payments
In early April, the Centers for Medicare & Medicaid Services (CMS) gave the public unprecedented access to physician pay- ments and charges for services and procedures provided to Medicare beneficiaries. The online database contains informa- tion on more than 880,000 physicians and other health care professionals who collectively received $77 billion in Medicare Part B payments in 2012 (
http://go.cms.gov/OCmyoy). Organized medicine, including TMA, has expressed concern
that the data, as is, could mislead the public if presented with- out context. For example, the data don’t account for physician expenses, such as drug and medical supply costs, investments in health information technology, and other expenses. Consumers accessing the data also likely don’t realize Medi-
care pays on average 61 percent of physicians’ overall costs. In Texas, Medicare covers about 3.2 million seniors and Texans with disabilities. “Just looking at gross payments can be inflammatory and doesn’t tell you what a doctor is really getting paid when all’s said and done,” TMA Immediate Past President Stephen L. Brotherton said. CMS acknowledges the limitations of the data, but maintains
the data will “assist the public’s understanding of Medicare fraud, waste and abuse, as well as shed light on payments to physicians for services furnished to Medicare beneficiaries,” of- ficials wrote in April to the American Medical Association. The data come from claims physicians submit to Medicare
for payment and include the number and type of health care services provided, a count of unique beneficiaries treated, the average submitted charges, and the average amount Medicare paid for those services. Organized medicine fought the physician data release in
court for more than 30 years. But last May, a Florida federal district court lifted a 1979 permanent injunction blocking the disclosures. TMA encourages physicians to seek out and review their claims information, and AMA released guidance (http://bit .ly/1gc1o8h) outlining the primary limitations people need to consider when evaluating physicians’ information.
July 2014 TEXAS MEDICINE 39
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