Delegates Prioritize Prior Authorization, Pandemic Relief
By Emma Freer

As private practices continue to navigate red tape and ongoing pandemic pressures, Texas physicians pushed the Texas Medical Association to do more to address onerous prior authorization requirements and to advocate for federal disaster loan forgiveness.

TMA’s House of Delegates heeded their call while tackling other important economic issues – including Medicaid coverage and payment to physicians, health insurance coverage, and telemedicine – during its annual voting session at TexMed in Houston on April 30.

On the prior authorization front, delegates voted to support legislation that requires payers to compensate physicians for the time they and their staff spend completing prior authorization requests. (Texas’ “gold-card” law to cut down on preauthorizations has yet to be implemented.)

Because of existing TMA and AMA policy, TMA’s Reference Committee on Socioeconomics received mixed testimony on the resolution. But supporters prevailed by stressing that existing TMA policies have done little to help physicians in the meantime. Dallas anesthesiologist Christopher Cook, DO, was among them.

“If we don’t find a mechanism to hold [payers] financially responsible, if we don’t hit them in the pocketbooks, they will not change,” he testified.

Pandemic relief emerged as another priority, with delegates calling on TMA to work to ensure disaster help for small practices.

The house adopted a resolution requiring the Texas Delegation to the American Medical Association to advocate for Economic Injury Disaster Loan forgiveness for groups of five or fewer physicians, for loans of less than $150,000, with no stipulations, at AMA’s annual conference in June. TMA’s Council on Socioeconomics endorsed the resolution, saying it could serve as a critical lifeline to practice privates still dealing with the financial hardships of the pandemic, such as decreased visits and increased overhead.

“Practices, especially small and rural ones, continue to struggle with business operations. Loan forgiveness programs without stipulations beyond physicians’ control would keep practices viable for patient care,” the council wrote in submitted testimony.

And again, delegates reaffirmed TMA policy addressing inadequate Medicaid physician payments, committing to develop a strategic plan to increase such payments as well as to study specifically how to do so for physicians practicing in health professional shortage areas. They also voted to improve Medicaid coverage and access for breast and cervical cancer treatment.

Building on these goals, the house voted to convene a cross-council workgroup to develop a comprehensive framework for affordable, accessible health insurance coverage options to guide TMA advocacy during the legislative session.

When it comes to telehealth coverage, the house moved to ensure any expansion doesn’t discourage the use of local physicians. Under updated policy, TMA will advocate against payers that unfairly favor visits with telemedicine-only companies and for the establishment of strong patient protections within virtual care networks to ensure patient access to in-person care.

During the marathon voting session, the house also approved other economic and regulatory-related policies that:

• Advocate for the state of Texas to pay for the costs associated with electronic prescription of controlled substances as well as for physicians’ time spent engaging with the Texas prescription monitoring program (PMP). Delegates also supported using a portion of state medical licensing fees to cover physicians’ PMP access costs no longer covered by the state.
• Strengthen existing TMA policy to support “adequate funding for the Texas Medical Board to enable the board to have sufficient staffing and resources to successfully fulfill its mission and responsibilities.”
• Support legislation requiring pharmacies to disclose to patients the lowest cost option for their prescribed medications, and support mandated price transparency in hospitals.
• Adopt principles for the use of augmented intelligence in health care.
• Recognize the public health benefits of paid sick leave and support employers that provide such leave.
• Promote paid parental leave that is mutually beneficial to employees, employers, and business owners.
• Address the physician gender pay gap, with a focus on the unique impact of COVID-19 on pay inequity.
• Adopt principles for value-based decision-making by physicians.
• Support “site-neutral” payment policies that ensure fair payment for outpatient services, regardless of whether they’re provided at a hospital-owned facility or physician office.