Texas lawmakers are considering bad medicine for physicians and patients

It’s hard to understand why our elected state lawmakers would want to get in the way of helping these Texans restore what was lost by making the practice of medicine more difficult — but that’s exactly what lawmakers are doing.

Texas Senate Bill 207, approved by the Senate Committee on State Affairs in late March, and its companion in the House, House Bill 1617, upend current state law designed to make civil litigation fair and efficient. In doing so, they set Texas on a path to government rate-setting for health care, putting independent physicians out of business and jeopardizing access to care for all Texans.

SB 207 allows anyone, regardless of their background, education and training or expertise, to challenge a health care professional’s medical judgment of necessary care and appropriate charges for that care. The legislation removes legal protections crafted over decades to allow someone taking a short on-line course to be called an “expert” and challenge, in my own case, nearly four decades of medical training and practice.

Inevitably, insurance companies will dispute the necessity of all medical care provided, including the opinion of every single health care professional who is involved in treating an accident victim — from the ambulance team on the scene to the surgeons and physical therapists. Providers will have to take precious time away from their medical practices to testify in court to defend their care plan and prove the validity, accuracy and integrity of medical charges.

In the House version of the bill, physicians can avoid these nightmare scenarios — but only by agreeing to accept payments tied to artificially low, government-set reimbursement rates. Physicians will be forced to accept payments that are a fraction of what the state workers’ compensation program pays, no matter how low those rates go. This bill holds physicians hostage by requiring them to accept payments that do not cover the costs of providing care. It encourages a race to the bottom for all physician reimbursement.

In what can only be described as irony, one of the senators voting for SB 207 in committee spoke out against government-set rates in a vote to oppose legislation last session banning surprise billing. Sen. Donna Campbell, R-New Braunfels, described that legislation as “a step in the wrong direction.”

“This bill moves our state closer to single-payer medicine and further away from doctors and hospitals being able to operate in a free market,” she said. The senator changed her to vote to support only when the bill was amended to eliminate payment benchmarks tied to government rates and those deemed “reasonable” by insurance companies.

Now, just two years later, bills are again moving through the Legislature with government payment amounts positioned as a fair and reasonable standard of payment. In their current forms, SB 207 and HB 1617 raise the specter of single-payer medicine.

Government rates, and insurance-set rates that use government rates as a basis for payment, do not cover the costs of providing health care, particularly for patients involved in personal injury cases. For many private physician practices in Texas already struggling to stay in business after the pandemic’s devastation, these bills will be the nail in the coffin, and the result will be fewer physicians practicing in Texas and longer waits for patients to get care. Tragically, in politics, it seems that patients always lose out.

Physicians are asking that lawmakers keep current law intact and allow only peer physicians to challenge medical charges and protect physicians from abusive legal discovery by insurance companies. We’re also asking that below-cost fee schedules not be held out as any kind of standard of fair and reasonable payment.

Senate Bill 207 and House Bill 1617, in their current forms, are bad medicine. They’re bad for accident victims. They’re bad for physicians. They’re bad for Texas. Our elected lawmakers should reject them.