AUSTIN, Texas — Texas patients will soon get quicker care.
House Bill 3459 passed, allowing physicians to earn a "gold card" exemption from some health plans' prior authorization requirements.
"When I see and treat a patient in the clinic, I diagnose them with their cancer and then frequently will order radiologic imaging studies like X-rays or CAT scans or PET scans," said Dr. Debra Patt. "When I order those studies frequently, they have to go through a prior authorization process."
Patt is the executive vice president of Texas Oncology and the former chair of the council on legislation for the Texas Medical Association.
As an oncologist, Patt said she deals with prior authorization more than most.
"My order might say, 'This is a patient with a clinical, stage three breast cancer. Please do a CAT scan of the chest and abdomen to evaluate for metastatic disease,'" said Patt. "But then that might go through a multi-day or multi-week prior authorization process that requires peer to peer review and frequent denials by insurance companies."
Now with the passage of HB 3459, physicians can earn exemption from some prior authorization review requirements if they have a record of enough previous approvals from state-regulated insurers or HMOs.
"And what that means if I'm a good actor, and I'm a good partner with payers and I tend to write for studies or radiologic imaging or radiation treatments or chemotherapy that is in alignment with the plan and tend to get approval, that if I do that successfully in a one, six-month period, for the next six-month rolling period, then I'm gold carded or that I have sort of a pass on going through this arduous process that deters the care of my other patients," said Patt.
She said this lessens the burdens faced by both doctors, staff and patients.
"It's really challenging for me, who went to school for like 27 years to do what I do, to know within five minutes how to treat someone's cancer, but to then spend upwards of 15 hours between me and my staff managing that care delivery, during which time when care is delayed and deterred, patients call frequently with anxiety," said Patt.
Patt said patients have enough to worry about without also stressing about a delay in care.
"I feel like it's a lot to manage. Someone's new fear about a new cancer diagnosis that's really common is they adjust to the fact that they have to now manage this new health issue in their life," said Patt. "But then for them to have fear about being able to get the staging studies that they need, for them to have fear about getting appropriate treatment is really challenging. And it's a whole new level of anxiety that patients have to manage."
The law goes into effect on Sept. 1.
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