The Senate Committee on Health & Human Services met on March 23 to take up a number of bills. This report covers discussions on SB 412 (Buckingham) relating to telemedicine and SB 1137 (Kolkhorst) relating to hospital price disclosures.

This report is intended to give you an overview and highlight of the discussions on the various topics taken up. It is not a verbatim transcript of the discussions but is based upon what was audible or understandable to the observer and the desire to get details out as quickly as possible with few errors or omissions.

SB 412 (Buckingham) Relating to telemedicine, telehealth, and technology-related health care services.

  • HHS has allowed additional flexibilities during the pandemic, HB 412 proposes to make most flexibilities permanent, addresses gaps in tech
  • CS is a lege council version of the filed bill with several nonsubstantive changes & immediate effect provision
  • Hall – COVID boosted telemedicine use; what can you tell us about the effectiveness of expanding telemedicine?
    • Was able to use telemedicine in ophthalmology, can be transformative for rural people to get the specialty care they need; appropriate reimbursement is a struggle
  • Hall – Is there anything we need to get ahead of to ensure there are no abuses?
    • Have tried to put guardrails in the bill to maintain quality
  • Hall – Good that we’re recognizing telemedicine is a legitimate tool, but need to be careful
  • Kolkhorst – You feel like this is pretty tightly crafted?
    • Yes, very open to any further suggestions for guardrails

Nora Belcher, Texas e-Health Alliance – For

  • During the pandemic providers shifted practice almost overnight, we saw expanded usage, but didn’t get rid of protections in place
  • Telemedicine use peaked in April around 40%, then began falling off; not expecting to stay at peak usage, projections show possibly 1 in 5 visits will be remote
  • Asking for continuity in the flexibilities granted during the pandemic
  • Would like to see tech gaps addressed like testing info transfer difficulties resolved in the bill
  • Kolkhorst – Isn’t it cheaper to do telemedicine than in-person?
    • Will be different depending on the practice, there were upfront costs for remote and digital conversion that will see savings over time
    • Patients will likely have different expectations know that they know they can receive remote services
  • Kolkhorst – Always trying to drive health care costs down
    • Important thing last session was language passed asking HHS to look at cost of telemedicine; study showed that population saw less ER visits
    • Bringing down hospital and ER visits is an important policy goal, telemedicine can redirect people away from more expensive services
  • Buckingham – Also offset some of the need for transportation costs
    • Hopeful that transportation costs are not as high, need to track data
  • Perry – New tech is expected to increase access, but can make it more difficult for a provider to meet those services and access expectations; probably will not help physicians with workload
    • Understand what you’re saying; would compare this to when we first started with EMR
    • There is work that needs to be done to ensure telemedicine is put into the workflow and medical schools train students appropriately
  • Kolkhorst – Mentions friendly amendment to encourage HHS to utilize telemedicine in lieu of some ER visits

Public Testimony SB 412

Laurie Vanhoose, Texas Association of Health Plans – For

  • SB 412 increases access, flexibility, etc.
  • Originally had restrictions on service/provider type that now have no evidence basis, would like these removed
  • While it doesn’t work for every client, should continue for those it does work for
  • Recommends taking a look at service coordination language, very prescriptive and generally encapsulated in contracts for flexibility
  • Allows client communication via text message, can boost care and visit compliance
  • Rate setting mandates harm cost saving ability under the bill

Dr. John Godfrey, Texas Psychological Association – For

  • Have found that high quality services can be provided through A/V and telephonic counseling, patients were relieved to receive care without risking infection
  • Audio-only services are very beneficial for population without broadband internet

Lee Johnson, Texas Council of Community Centers – For

  • Maintained and sometimes increased services delivered during the pandemic
  • Several beneficial factors identified by clients include no need for child care, no need for transportation, ability to keep appointments, etc.
  • Remote services, incl. audio-only, should be allowed when appropriate

American Substance Abuse Professionals – For

  • COVID was devastating for people with substance abuse disorders; able to rapidly switch to telehealth and became a lifeline
  • Telehealth removed barriers like transportation, inability to keep appointments
  • Should consider codifying emergency rules for substance abuse services via qualified staff and interns, submitted language to Sen. Buckingham’s office
  • Kolkhorst – Concerned about pandemic accelerating isolation & psychological impact

Jorge Martinez, LIBRE Initiative – For

  • Telehealth has increased access and service delivery

Sheila Hemphill, Texas Right to Know – On

  • Appreciates the purpose of bill, but cautions that sometimes people don’t know when they need to see a doctor; important to have an in-person visit

Samuel Sheets, Americans for Prosperity – For

  • Comprehensive bill that provides access to affordable, quality care

John Hawkins, Texas Hospital Association – For

  • Appreciate putting actions taken during the pandemic into law, may cost more to keep people out of the ER; appreciate audio-only option
  • Have come up with language concerning taking and storing informed consent
  • Kolkhorst – May cost to keep people out of the ER
    • Some things we may want to pay more for, some less; referring to comment earlier that this could keep patients out of emergency services

SB 412 left pending

SB 1137 (Kolkhorst) Relating to the required disclosure by hospitals of prices for hospital services and items; providing administrative penalties.

  • Received phone call from CMS, encouraged us to go even further, WSJ wrote an article about the CMS price transparency rule & efforts in Texas
  • SB 1137 tracks the CMS price transparency rule, requires HHS to enforce compliance with price transparency
  • Have issued with hospitals not complying and burying compliance
  • Creates joint state and federal effort to ensure compliance with price transparency rule, multiple methods of compliance allowed under bill and CMS rule
  • Price transparency tends to drive costs lower

David Balat, Texas Public Policy Foundation – For

  • SB 1137 builds upon an executive order allowing patients to see real prices, establishes requirement as a condition of licensure
  • Abysmal compliance rates currently, more often larger hospital systems are out of compliance
  • Kolkhorst – What are you seeing out there with noncompliance
    • Hospitals are using cost to prevent average person from finding prices

Vance Ginn, Texas Public Policy Foundation – For

  • Prices are transparent in many other sectors of health care industry, should know price of services provided when visiting hospitals; hospitals need to provide more transparency
  • Need to put CMS rule into law
  • Perry – It’s better, people in my district can actually shop for MRIs
  • Kolkhorst – Neither SB 1137 or CMS rule require ambulatory services to publish charges, do you know why the CMS rule doesn’t cover this?
    • Can check and get back
  • Kolkhorst – Area where there could be some leakage
  • Perry – Ambulatory surgical and free-standing ERs have come a long way with networks and transparency

Public Testimony SB 1137

John Hawkins, Texas Hospital Association – Against

  • Have consistently supported legislation focused on reducing health care cost
  • Many health systems have created price estimator tools
  • Not sure if mass public provision of private negotiated prices is the best way to tackle this; could focus on patient responsibility portion
  • Interaction with high-deductible health plans is a different issue; need to focus on preventative care, benefit design, care coordination etc.
  • Kolkhorst – What are you doing with the CMS rule?
    • One of our concerns is cost of compliance, breadth and cost to post according to rule has been difficult in the middle of the pandemic; many working on this
  • Kolkhorst – Heard about price calculators, etc. that state could do; willing to work with you

Charles Miller, Texas 2036 – For

  • Significant number of Texans have skipped care due to not knowing what cost is, in addition to those delaying treatment; transparency is an access, affordability, and coverage
  • Will allow employers to design plans more intelligently with public info, cannot do this if info is hidden
  • Perry – Should be access, affordability, coverage, and quality
    • Not arguing with hat, perhaps could redesign as value
  • Kolkhorst – Up to 50% of women skipped care due to prices
    • 57% of women with children
    • Heard many anecdotes from people concerned of losing financial control
  • Perry – Discusses “shop docs” who provide basic services for flat fee; for most care you need primary physician referral, cost of services and gatekeeping by insurance companies is intimidating
  • Perry – Insurance has found a way to cut costs by cutting off access
  • Kolkhorst – If we could get this tool to work, people are more comfortable looking through prices online and figuring out cost rather than contacting the hospital directly
    • Absolutely, different people feel comfortable accessing info in different ways

Sheila Hemphill, Texas Right to Know – For

  • Love this bill, until you are hospitalized you don’t know the cost of everything involved
  • Highlights risk of brain inflammation due to COVID causing mental health issues

SB 1137 left pending

Closing Comments

  • Kolkhorst – Intending to vote out a number of bills via desk vote on Thursday after the Senate floor