Texas’ House Bill 7 Workers’ Compensation and Quality Care
House Bill 7 is being hailed as the last best hope for the failed Texas Workers’ Compensation system. Texas Senator Todd Staples (R Palestine) said it’s something “worth bragging about.” Businesses, insurance carriers, and the medical profession all agree there’s a lot of potential with this bill to make positive changes. Others are not so sure.
HB7 eliminates the Texas Workers’ Compensation Commission that has, in the eyes of everyone, failed to live up to its job. All functions of the Commission will now fall beneath the masthead of the Texas Department of Insurance where a single commissioner will take the place of the six-member commission. There are other changes to the system that will have an impact but none more than HB7’s creation of workers’ compensation healthcare networks.
TDI held a stakeholders meeting on the networks July 12 in Austin. The major players involved with this reform bill such as the Texas Medical Association and the Texas Association of Business did not give voice to their concerns at the meeting. Instead, the floor belonged to many who feel the bill may leave them on the outside looking in at the new Texas’ Workers Compensation system. Many there felt their jobs were on the line. One Chiropractor said he felt like there was a “big target on his back.” Chiropractors and Physical Therapists have been blamed for the high costs in workers’ compensation medical care.
Doctors are caught in the middle. The number of doctors who will see workers’ compensation patients has dwindled from seventy percent to thirty percent according to Dr. Steve Norwood, an orthopedist who spoke at the meeting. He pointed out the Approved Doctor List maintained by TWCC held the names of many doctors who were there only so they could practice in emergency rooms. Doctors have quit the system because of the enormity of red tape, low fees, slow reimbursement and other problems with the system. Unless these things are changed and unless the focus of the new networks is on quality care most doctors will not be in a hurry to return.
HB7 has a remarkable amount of support. Business believes it will lower costs, carriers believe it will be a more manageable system, even doctors think it has the potential to make a big difference in the quality of care. But some do not look upon HB7 and especially the creation of networks as a good thing. Chiropractors view the new regulation as a ploy to get them out of the system. Physical therapists also feel the pinch. They see themselves taking a lesser role in networks, being over-ruled by primary physicians, restricted from properly treating injuries, especially through what they believe to be vital work hardening programs.
Third party support businesses and small clinics sent representatives to the July 12 meeting worried about their place in the system. Rosa Perales of Edinburg, a nurse at a small clinic, spoke passionately about the care they give to people in the community. Networks are frightful things to clinics like the one where Perales works. Genuine worry was in her voice when she asked how hard it would be to get into a network.
Livelihoods are on the line for those businesses and care providers who spoke to TDI. It’s not so much livelihoods as lives on the line, however, workers groups say. Workers’ rights groups do not see HB7 as a panacea. It’s just more of the same to them. The system failed them, they say. At the top of the list is TWCC, a state agency filled with corruption, ineptitude and incompetence.
The problem has not been the rules as much as it has been a complete disregard for the rules, especially by insurance carriers, and no enforcement by TWCC. Selene Ballestas from Houston, speaking as a concerned citizen, told TDI that the credentialing process is very important. Selection and credentialing of doctors as well as treatment guidelines are left to the discretion of networks in HB7. Ballestas also reminded TDI that there is a legal side to a workers case. Doctors should be given latitude and opportunity to fight for an injured workers rights, she said.
Ballestas is employed at a law firm in Houston where she says she’s seen many instances of workers being denied benefits and treated unfairly by the system. In a gathering of individuals concerned about worker rights outside the conference room Ballestas said carriers would deny claims as a rule without consideration of the circumstance. She said the decision to cover an injury was left up to adjusters who had no medical training or understanding. This was reiterated by a physician who participated in the conversation. The doctor also stated TWCC would not enforce the rules. Carriers ran rough-shod over workers and physicians alike, the doctor said. Workers were denied claims and doctor bills went unpaid and TWCC would do nothing at all.
Is House Bill 7 a good bill? It depends entirely on whom you ask. Small medical businesses, clinics, chiropractors and therapists feel threatened by its provisions. Business and insurance carriers have placed high hopes in it. Doctors are “cautiously optimistic,” TMA representative David N. Henkes said recently. Workers can’t deny the potential of HB7 but lean far to the skeptical side. “House Bill 7 is all about saving money,” Selene Ballestas said. The bill calls for changes that can be good or bad for every party involved. Everything hinges on how TDI interprets the law and what they put into the rules governing the new system. When the little group of worker advocates were asked if all the problems they talked about would change with this new bill their unanimous answer was, “no.” TMA representative Henkes said the bill could be a good thing or a “miserable failure.” It’s all going to depend on how HB7 is translated into law and policy. “The devil is in the details,” said Cathy DeWitt of the Texas Association of Business. The next few months will tell if there is a devil in HB7 or if it’s a gift from above.
