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Texas Doctors Are Losing Money During The Pandemic. They Want Lawmakers To Make Insurers Pay Up

A doctor, on the right side, is about to test a patient's reflexes with a small hammer aimed at the knee. Neither the doctor's nor the patient's faces are shown.
Martin do Nascimento
/
The Texas Tribune
A family physician trade group wants state lawmakers to reform how insurance companies pay their practices. It says the coronavirus pandemic has created financial problems that could cause many physicians to close their offices.

The Texas Academy of Family Physicians is also asking legislators to expand Medicaid insurance coverage to low-income adults and restore funding for a program that studied racial health disparities.

Texas primary care doctors say they’re hemorrhaging cash and at risk of closing their doors during the coronavirus pandemic, and a new trade group proposal argues it’s time for Texas lawmakers to overhaul how physicians’ practices get paid.

More patients are forgoing office visits as they stay home to avoid the virus, and doctors’ offices report that their revenues have fallen sharply as a result. Many large health insurance companies have posted huge profits during the same period.

A family physician trade group wants insurers to share the wealth, and with four months before the 2021 legislative session is scheduled to begin, they’re asking state lawmakers for help. The Texas Academy of Family Physicians calls its proposal a “Primary Care Marshall Plan,” a reference to the massive program of U.S. investment to help parts of Europe rebuild after World War II.

“Just as the aftermath of war offers an opportunity to rebuild, the devastation COVID-19 wrought on our health care system and our economy gives us the opportunity to rebuild a better, more cost-effective system of care,” the proposal says.

The physician group, which represents nearly 10,000 members, is also asking for other reforms, such as new state laws to make it easier for physicians to get paid for seeing patients via telemedicine. It’s calling on the Texas Legislature to expand the Medicaid public insurance program to cover poor adults, which would lower the state’s uniquely high uninsured rate and increase the number of paying customers at doctors’ offices. And it wants lawmakers to restore funding to a program that studied health disparities among racial groups until it was defunded in 2017.

But payment reform is their No. 1 demand, with the proposal calling for state-governed health plans to move away from the traditional “fee-for-service” payment model. Under that system, the mainstream in American medicine, physicians bill insurance companies based on each discrete service they provide, such as an office visit, lab test or immunization.

The doctors instead want insurance companies to embrace a “prospective payment” model, in which insurers pay physicians a set fee per patient each month, akin to a subscription service.

Those changes are necessary to keep primary care physicians’ offices afloat, doctors say.

“Multiple insurers have made record profits, and their good fortune with corona[virus] is done on my back, in a sense,” said Dr. Erica Swegler, a family physician in Austin.

The number of patients coming to Swegler’s office fell by more than half this spring during Gov. Greg Abbott’s stay-home order. Now she estimates she’s seeing somewhere between 70% and 80% of normal patient volumes. But many of those patients are opting for remote telemedicine visits, which Swegler says yield stingier payments from health insurers.

At the same time, some costs of doing business have grown during the pandemic, with items like gloves and masks demanding twice their pre-pandemic prices. As a cost-cutting measure, she said her office no longer carries a supply of vaccines on hand.

Swegler’s monthly revenue is down about $5,000 to $10,000 per month, which she says she has only been able to swallow by deferring loan payments, depleting a retirement fund and taking a pay cut.

“We are literally hanging in, so it’s a day-by-day, week-by-week thing,” she said.

Some 8% of U.S. doctors reported shuttering their practices in the past four months because of the coronavirus, according to an August survey published by the nonprofit Physicians Foundation. More than 40% reported cutting staff.

Congressional bailouts such as Paycheck Protection Program loans have helped delay a spate of closures, doctors say, but those funds are drying up.

Dr. Christopher Crow, chief executive of the Catalyst Health Network, which includes nearly 1,000 primary care providers in North, Central and East Texas, said health insurers are warming up to the idea of prospective payments.

In the North Texas market, the physician network has agreements with two major insurers to enter such a payment arrangement, said Crow, who aims to sign with two more by 2022.

Virtually all of the network’s members have taken pay cuts this year, he said. If more primary care doctors go out of business, he said, more patients will miss out on preventive health care and end up receiving expensive emergency care later.

“The fact that we don’t supply good primary care means that we are taxing the citizens of Texas for more expensive health care in the future,” he said. “It is absolutely fiscally irresponsible, not to mention morally irresponsible.”

The Texas Tribune provided this story.

Disclosure: The Texas Tribune, as a nonprofit local newsroom and a small business, applied for and received a loan through the Paycheck Protection Program in the amount of $1,116,626.