Socioeconomics Committee New name, bigger game

by Shellie Pruden, DCMS director of medical practice relations

To better serve member physicians, the DCMS Board of Directors has expanded the scope of the Managed Care Committee to include socioeconomic issues. The new Socioeconomics Committee, chaired by Presley M. Mock, MD, will study, recommend, and engage in activities related to the socioeconomic aspects of medical care and regulations. It will advocate appropriate patient service and viable physician practices through development of policies and member services, promote quality outcomes in the physician-patient relationship by helping members practice efficiently in managed care and other rapidly changing settings, and serve as a resource to the TMA Council on Socioeconomics.

The committee will continue its focus on managed care issues and education. Preparations are underway for the 4th annual Managed Care Expo in the fall, and other educational opportunities will be offered throughout the year to help practices improve business operations. In addition, DCMS will host general office manager meetings beginning May 16 to help DCMS stay in touch with the daily operations of your practice and provide a venue to share resources that assist with practice management. Member physicians and their staffs also can attend the quarterly Medicaid Advisory Committee meetings, next set for 4:30 pm May 29 at DCMS. This meeting brings together the state agencies, enrollment broker, health plans, and related agencies for Medicaid managed care, CHIP, Texas Health Steps, and NorthSTAR programs to resolve issues related to caring for patients enrolled in these programs.

In preparation for the 2003 legislative session, the committee will gather information to support physician advocacy with liability, Medicaid, Workers’ Compensation, prompt payment, and other issues that affect patient care and the socioeconomic viability of medical practices. Physicians can receive electronic updates regarding these issues by registering on the DCMS Web site at www.dallas-cms.org.

Physicians are well aware that premiums for liability insurance have skyrocketed. Last fall, the TMA Board of Councilors approved a multipronged strategy to assist with the reduction of premiums, eliminate red-lining practices, and facilitate tort reform. To complicate matters, in the last year, the market has been reduced from 17 malpractice insurance carriers to four.

Malpractice isn’t the only area of debate in the insurance arena. Sen Jane Nelson (R-Flower Mound) chairs a Senate Special Committee on Prompt Payment of Healthcare Providers, charged with investigating barriers that prevent timely payment for physician services. Physicians’ practices prove that the current legislation is ineffective. Not only is the legislation ineffective, the Texas Department of Insurance continues to struggle with jurisdiction and enforcement. With a vague definition of “clean claim,” few physicians are able to file a claim that would be protected under the current legislation. Therefore, the claims are not required to be paid in 45 days and are ineligible for restitution. The Legislature must find a balance that gives plans incentives to pay claims timely, yet refrain from over-restricing that would cause plans to leave the Texas market.

Medicaid and related public sector programs are coming under redesign directives from federal and state agencies. Viable changes must be made to the program that would have physicians choose to participate. The TMA Council on Socioeconomics has appointed an ad hoc committee on Medicaid to address regulatory initiatives, including reorganization, simplification, cost containment, revised payment, and expansion of Medicaid managed care.

The Texas Workers’ Compensation Commission continues to develop rules to implement legislation passed in 2001. In a cost-containment move, the Commission proposed a reduction in service fees. TMA and the governor’s office have discouraged this action taken without significant study of the repercussions. A further reduction in fees would significantly decrease the number of physicians who participate in the Workers’ Compensation program.

The next year will be critical in the financial future of private practice. The new Socioeconomics Committee takes seriously the charge of assisting physicians with issues that affect patient access, quality, and financial viability of medical practices.