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Texas Medicine

Texas Medicine


A Fresh Set of Eyes

Tue, 05 Sep 2017 18:33:12 GMT

For prior authorizations, insurance companies often require peer-to-peer conversations between a patient's physician and another physician to determine whether the treatment is necessary. These conversations often result in Texas doctors explaining the necessity of the treatment to a physician who's not licensed in Texas and/or is in an unrelated specialty.

A Peer? Nowhere Near

Tue, 05 Sep 2017 18:35:42 GMT

Health plans regulated by the Texas Department of Insurance (TDI) must give a practitioner a chance to explain to a physician why a treatment is medically necessary or appropriate before a utilization review agent denies the request. Texas laws and TDI regulations don't expressly state that a physician who handles a peer-to-peer call has to be of the same or a similar specialty.

Steering Clear of Trouble

Fri, 01 Sep 2017 13:32:26 GMT

Pharmacies that compound topical creams and gels of questionable or nonexistent efficacy and then bill insurance for huge amounts are a growing problem, especially in the Texas workers' compensation program. Sometimes, they convince physicians to play a part in their schemes, offering kickbacks or other inducements in exchange for referrals. It's a nasty business doctors need to know is out there — and strictly avoid.

Fulfilling a Dream

Sat, 02 Sep 2017 14:13:10 GMT

The University of Texas Rio Grande Valley School of Medicine has largely dispensed with lectures and focuses more on group learning and practical experience. This and other innovations dovetail with the school's focus on public health, which is vital in a region notorious for high poverty and chronic health problems.

Heavy Resistance

Fri, 01 Sep 2017 13:31:11 GMT

Prior authorizations started as a way to control the cost of prescription drugs. But in recent years, they've ballooned into an industry within the medical industry ― one that touches almost everything doctors do for patients. Agreements between health plans and participating physicians now regularly include rules that allow insurers to require prior authorization on the medical need for surgery, imaging, and medication ― in fact, just about every kind of treatment or test.

What You Need to Know About ACEs

Fri, 01 Sep 2017 13:33:44 GMT

Medical evidence shows that the more abuse and neglect children endure, the greater their chances for developing physical and mental health problems over time. Adverse childhood experiences can be a contributing cause for health behaviors that place an individual at risk for chronic conditions, such as diabetes, depression, and heart disease.

Access to Care of Low-Income Adults: Local Safety Nets Compared With Medicaid

Fri, 01 Sep 2017 13:34:08 GMT

Under the Affordable Care Act, Texas could expand Medicaid to low-income adults. However, the state has not done so and relies on safety net programs to meet the needs of this population. The policies of President Trump's administration favor flexibility for states to design Medicaid programs. This may lead to expansions that integrate safety net components. Using data from a 2010 survey conducted in Houston, Harris County, we provide evidence on access to care differences between low-income nonelderly adults with Medicaid and those obtaining services through the Harris County Hospital District's Gold Card safety net program. We compared Medicaid and Gold Card access to that of the uninsured using five measures. After controlling for personal characteristics, access was similar for Gold Card and Medicaid beneficiaries, and access for both was significantly better than that for uninsured adults. This suggests that well-structured safety net programs and Medicaid can improve access.