Organized medicine sent an army of physicians – including Texas Medical Association President Diana Fite, MD, and Texas Ophthalmological Association President Mark Mazow, MD – to tell the Senate Business & Commerce Committee today why a bill giving therapeutic optometrists the authority to perform a lengthy list of surgical procedures is a short-sighted idea.
Also lined up to testify against Senate Bill 993 by Sen. Kelly Hancock (R-North Richland Hills) were a pair of patients who suffered complications at the hands of out-of-state optometrists performing surgery or otherwise practicing outside their scope of practice.
Dr. Fite told the committee that optometrists don’t have the training to handle anything the bill would give them authorization to do, and she’s certain the expansion of their scope of practice would lead to patient harm. There’s no shortcut or substitute to becoming a physician and surgeon, she added, and there’s no access-to-care crisis when it comes to patients receiving high-quality eye care.
Expanded Medicaid coverage for new moms
The house of medicine also made its case today to the Texas House Human Services committee to help keep young mothers healthy and alive – and to address the racial and ethnic disparities in maternal health.
Houston obstetrician-gynecologist Lisa Hollier, MD, professor of obstetrics and gynecology at the Baylor College of Medicine, testified for the Texas Medical Association in support of House Bill 133. The bill by Rep. Toni Rose (D-Dallas) would require Texas Medicaid to cover enrolled women for at least one year after they give birth or involuntarily miscarry. Women on Medicaid typically lose coverage 60 days postpartum.
Dr. Hollier noted in her written testimony that Black women are two to three times more likely than white women to die during or after pregnancy. She also cited a December 2020 report from the Texas Maternal Mortality and Morbidity Review Committee that found 31% of pregnancy-related deaths in 2013 had occurred between 43 days and one year after the end of the pregnancy.
The Review Committee has recommended the state increase access to comprehensive health services in the year after a pregnancy, Dr. Hollier noted, “throughout the preconception and interpregnancy periods to facilitate continuity of care, enable effective care transitions, promote safe birth spacing, and improve the lifelong health of women.”
The state has taken important steps in recent years to improve maternal health with the formation of the Healthy Texas Women (HTW) and Family Planning programs, which provide basic primary and preventive care, Dr. Hollier said.
She also praised the 2019 Legislature for passing SB 750 by Sen. Lois Kolkhorst (R-Brenham), which paved the way for the creation of HTW Plus. That program provides a year of coverage for the most common conditions that contribute to maternal death: substance abuse, perinatal mood disorders, and cardiovascular disease.
“HTW Plus provides a tremendous foundation on which to build,” Dr. Hollier wrote. “Quality patient care means treating the whole patient, so by enacting HB 133, Texas will be able to truly optimize women’s health outcomes and reduce maternal deaths by providing coverage for a full array of postpartum services.”
The $1.9 trillion congressional COVID-19 relief package that passed earlier this month, also known as the American Rescue Plan, offers states a five-year funding incentive to extend Medicaid coverage to one year postpartum.
Policing preauthorization
Prior authorization is also in TMA’s sights today. San Antonio radiologist Ezequiel “Zeke” Silva III, MD, was scheduled to relay TMA’s support for House Bill 2142 by Rep. Hubert Vo (D-Houston), which would hold insurers accountable to state rules and regulations.
Insurers that offer PPO or EPO plans (as well as HMOs) must follow certain Texas Department of Insurance (TDI) requirements on preauthorization, including transparency and timelines for approving or denying prior authorization requests. HB 2142 would require TDI to conduct examinations of those health plans at least annually to make sure they’re doing what laws and regulations require.
Medicine’s main concern – as Dr. Silva was to tell the committee – is a delay of or negative impact on patient care if insurers aren’t following the rules.
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