Texas Senate Bill 7's Surprises

"I mean, people have access to health care in America. After all, you just go to an emergency room."--President George W. Bush, July 2007

That's fixin' to change.  Texas Senate Bill 7 states on page 20:

...the executive commissioner of the Health and Human Services Commission shall adopt cost-sharing provisions that encourage personal accountability and appropriate utilization of health care services, including a cost-sharing provision applicable to [require] a recipient who chooses to receive a nonemergency [a high-cost] medical service [provided] through a hospital emergency room.

The ER will have to conduct a medical screening exam to determine the situation is not an emergency.  Clerical staff will intervene to collect the cost sharing.  How will the patient respond?   It could depend on why they presented to the ER in the first place.  Many Medicaid repeat hospital users have mental health diagnoses.

SB 7 plans to reward hospitals for good performance:

...the commission shall to the extent feasible adjust child health plan and Medicaid reimbursements to hospitals, including payments made under the disproportionate share hospitals and upper payment limit supplemental payment programs, in a manner that rewards or penalizes a hospital based on the hospital ’s performance in reducing potentially preventable readmissions and potentially preventable complications.

The Commission released its Potentially Preventable Readmissions Report for 2009 in 2011.  Hospitals will be rewarded or punished based on data well over a year old. 

The commission must provide the report required under Section 536.151(b) to a hospital at least one year before the commission adjusts child health plan and Medicaid reimbursements to the hospital under this section.

It appears there will be a two year gap, one to produce the report, followed by the required year wait.  How would B.F. Skinner's rat respond if the food pellet or shock came long after it pushed the bar?

There is a common caveat to the planned reward schemes.

The commission may implement financial incentives under this section only if implementing the incentives would not require additional state funding because the cost associated with th eimplementation would be offset by expected savings or additional federal funding.

They must save money or be funded from Washington, D.C.  

The commission may develop a quality-based payment system for health homes under this subchapter only if implementing the system would not require additional state funding because the costs associated with the implementation would be offset by expected savings or additional federal funding.

The bill is chock full of extrinsic motivators for providers:

the executive commissioner may approve efficiency performance standards that may include the sharing of realized cost savings with health care providers and facilities that provide health care services that exceed the efficiency performance standards. The efficiency performance standards may not create any financial incentive for or involve making a payment to a health care provider or facility that directly or indirectly induces the limitation of medically necessary services.

It's a shame health care providers need to be bribed.  I thought they had good work to do.