Politics They play a part in your bottom line

by Robert T. Gunby Jr, MD, TEXPAC board chair

On Nov 5, again you will have the honored American privilege of voting to elect the public officials who will govern the federal, state, and local governments. As you collect your thoughts on how to cast your vote, consider this:

At the end of the 77th legislative session, Gov Rick Perry vetoed a ground-breaking bill that would have comprehensively collapsed the many loopholes insurance companies use to delay payment for legitimate healthcare services delivered to commercially insured patients. With a questionable political excuse of not wanting to increase the number of lawsuits filed in this state, the governor directed the Texas Department of Insurance to clean up the problem. At the time, physicians were owed an estimated $1 billion on commercial insurance claims in excess of 60 days. At the governor’s direction, TDI fined 47 insurers more than $20 million for late claims payment and ordered restitution. Insurers since have paid $36 million, but only about $14 million of that has been paid to physicians. Although appreciated, the order was a meager attempt to placate Texas physicians.

It’s easy to draw a direct correlation between state political leadership and the financial strain in current medical practices. Had the bill passed, insurers would have paid billed charges, losing access to deep discounts, and paid interest on commercial claims not paid within 45 days. In addition, staff resources used to coordinate benefits would be eliminated because the legislation gave health plans the ability to elevate this process to an insurer-to-insurer function. Insurers would have been required to disclose all fee schedules, and use Current Procedural Terminology codes, notes and guidelines, modifiers, and generally accepted bundling logic and edits. Claims filed by noncontracted physicians would have been covered by the statute for emergency room care and if no other contracted physician were available to provide service.

The governor never indicated he was unhappy with any provision of the bill. Given the comprehensive fixes to the no pay, slow pay scenarios, any portion of the bill could have been renegotiated or eliminated rather than jeopardize the entire bill. In fact, that same scenario played over and over, 82 times, before the ink ran out of his veto pen.

Prompt payment of healthcare claims isn’t a problem unique to Texas. More than 40 states have passed prompt payment laws to assist hospitals and physicians with timely payment. Other state regulatory agencies struggle with the same issues as TDI. Current statutes are inadequate to allow a comprehensive cleanup of a system riddled with loopholes, confusing contractual provisions, and financial concerns. Since the veto, TDI has processed more physician complaints than during any other time. Clearly, the intent of the past four legislative sessions must be codified in statute to ensure timely payment on legitimate claims.

With a liability crisis, possible professional tax, prompt payment, and Medicaid issues threatening patient access to quality health care, every physician must know how the candidates stand on healthcare issues and vote for the best candidate. Democrat or Republican makes little difference. What is essential, and makes sense for Texas physicians and their patients, is electing leaders who are willing to support good business practices and protect a patient’s ability to access quality health care. To see endorsements by TMA’s Political Action Committee in the November general election, log on to www.dallas-cms.org.