Watered-down bargaining bill becomes law in Texas
Watered-down bargaining bill becomes law in Texas
Texas Gov. George W. Bush has signed into law a bill that will allow Texas physicians to collectively negotiate with managed care organizations, but late amendments slipped into the legislation may water down its effectiveness, experts say.
The bill, SB 1468, gives physicians the right to negotiate jointly on a variety of quality of care issues, ranging from patient education to reimbursement methodology. But it doesn’t give them the right to negotiate fees unless the health plan they’re dealing with has "substantial market power," and the terms and conditions being negotiated have already affected or threaten to adversely affect the quality and availability of patient care.
The problem is, the law fails to define "substantial market power," leaving that judgement up to the discretion of the state attorney general. The attorney general also has the power to veto any contract agreement reached under the law.
A second restriction is that no more than 10% of all physicians in a given market are allowed to band together to negotiate. Physicians also can’t meet to organize any cessation, reduction, or limitation of health care services such as strikes or slowdowns.
Further, opponents claimed that the bill, as written, would have effectively outlawed "tied-products" clauses, which require physicians to take all of a health plan’s products instead of selecting among them.
As a result, language was added to the bill to prohibit physicians from raising the tied-products issue in negotiations. That concession doesn’t sit well with the Austin-based Texas Medical Association (TMA), which contends that the original bill said nothing at all about tied-products.
"People were claiming that it would allow doctors to cherry pick, and poor people and elderly people in Medicare and Medicaid HMOs wouldn’t be able to find a doctor to take care of them because doctors wouldn’t opt to be in those plans," says Ken Ortolon, a spokesman for the TMA. "Well, there was no reference to tied products in the bill whatsoever. The real disingenuous thing about the whole argument was that Aetna — the only company in the state that has a tied-products clause — doesn’t write any Medicare or Medicaid managed care plans in this state. So, there were no patients to be cherry picked in the first place."
The real significance of the Texas law may be its impact on other states and on Congress, which is currently considering an exemption to federal anti-trust laws that would allow physicians in private practice to negotiate collectively. "We’re very pleased that a major state like Texas has passed the law and that Governor Bush has signed it, especially since he is a major presidential candidate," says Suhail Khan, an adviser to Rep. Tom Campbell (R-CA), who sponsored the federal bill. "It definitely gives a little more attention to the issue and underscores the need for this type of relief. But the real problem is at the federal level."
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