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sas5814

Teledoc Vs Texas Medical Board

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Our medical board seems to frequently make decisions outside their mandate mostly oriented towards protecting the financial interests of physicians in Texas. They have repeatedly tried to stop telemedicine and get spanked every time. This is just one instance and we, the taxpayers, foot the bill for defending them in these cases. Recently the Supreme Court ruled the states could be held responsible for the actions of these boards who are virtually unsupervised and seem to answer to no state authority. They recently lost a federal case where, from the board, they tried to regulate practices to stop PA ownership and retroactively strip existing owners of their practice.

 

http://www.teladoc.com/news/2015/05/29/federal-court-rules-in-favor-of-teladoc/

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Welcome to Texas!

The Bible Belt full of good ole' boys who make unilateral decisions just based on whatever..................

 

Born and raised there. PA educated there.

 

Left nearly 20 years ago. A nice place to grow up but getting more funky everyday.

 

I am embarrassed by Rick Perry and Ted Cruz and all the others. 

 

Sorry to hear how bad it still is.............................

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P.S. 

I don't endorse or like telemedicine. Just me.

Too fraught with mistakes and disasters in the making.

 

I do not endorse the TMA doing what they do, though.

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Our medical board seems to frequently make decisions outside their mandate mostly oriented towards protecting the financial interests of physicians in Texas. They have repeatedly tried to stop telemedicine and get spanked every time. This is just one instance and we, the taxpayers, foot the bill for defending them in these cases. Recently the Supreme Court ruled the states could be held responsible for the actions of these boards who are virtually unsupervised and seem to answer to no state authority. They recently lost a federal case where, from the board, they tried to regulate practices to stop PA ownership and retroactively strip existing owners of their practice.

 

http://www.teladoc.com/news/2015/05/29/federal-court-rules-in-favor-of-teladoc/

 

Honest question- how does the link you provided relate to PA practice ownership?

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Honest question- how does the link you provided relate to PA practice ownership?

I'm not sure how you mean the question. This is a state specific discussion for Texas not a practice ownership discussion.

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I'm not sure how you mean the question. This is a state specific discussion for Texas not a practice ownership discussion.

 

Your last sentence ties your post into PA practice ownership, referencing a case where the board tried to stop PA ownership in Texas.  Do you have a link for this case you referenced for us to read?

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I believe he may be stating that the TMB doesn't have the greatest track record with regard to fighting restriction to practice cases.  Me personally, I don't know that I'd be too keen on utilizing it (my employer's insurance coverage offers it) since it would be a half-ass attempt to provide care in my opinion (in logistical cases, half-ass is better than no-ass I guess), but that being said, what isn't in the majority of low acuity illnesses?  All we're primarily doing is looking for bad things that the pt. doesn't know enough about to hone in on or those serious cases which should be fairly self apparent (cough, fever, increased respiratory rate, low pulse ox, and looks sick).  We all know that everyone gets a door prize when we're done with them (abx.) anyway.  No door prize, no coming back, no income, no business (or for those in the ED, pt. satisfaction scores).

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I believe he may be stating that the TMB doesn't have the greatest track record with regard to fighting restriction to practice cases.  Me personally, I don't know that I'd be too keen on utilizing it (my employer's insurance coverage offers it) since it would be a half-ass attempt to provide care in my opinion (in logistical cases, half-ass is better than no-ass I guess), but that being said, what isn't in the majority of low acuity illnesses?  All we're primarily doing is looking for bad things that the pt. doesn't know enough about to hone in on or those serious cases which should be fairly self apparent (cough, fever, increased respiratory rate, low pulse ox, and looks sick).  We all know that everyone gets a door prize when we're done with them (abx.) anyway.  No door prize, no coming back, no income, no business (or for those in the ED, pt. satisfaction scores).

 

I'm aware of all that, and as a PA in Texas as well I'm interested in seeing PA's be majority practice owners as they can be in other states.  Which is why I am very interested to hear what exactly the TMB did or has done to restrict PA practice ownership.  And he referenced a case involving the TMB and PA practice ownership.  I'd just like to read about it, because it sounds like SAS knows quite a lot about it

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It is a bit of a long story. PAs in Texas had plenty of work arounds to permit practice ownership and there were a couple of hundred PA owned practices in Texas. Some physicians in the valley didn't like competing with some PA owned practices so they made a complaint to the board. The board announced its intention to simply forbid physicians from working in PA owned practices. TAPA got involved and negotiated an agreement that forbade PAs from having more than 49% ownership of a practice. They considered this a good deal and touted it as a huge step forward in "officially allowing" PAs to own practices. It wasn't but that is another whole long story. Then the medical board wrote a rule stating practices currently owned by PAs would become subject to this rule if the physician supervisor changed. This , in essence, would take the practice away from the PA owner and/or force its sale. One physician down on the coast intentionally resigned as a physician supervisor in a PA owned practice and then bought the same practice in a fire sale. Myself and a group of PA practice owners (I don't own a practice. It is just a subject I have some passion for) created an organization called "The Physician Assistant Political Alliance" and sued the board in federal court. We attempted to have the whole thing over turned and had some success. The rule still stands but making the change retroactive in any way was found by the court to be improper. The ruling was upheld when the board/state appealed the decision. The cost to the group that financed this case was about $200k and , of course, we the taxpayers in Texas paid for the state to defend the board. I can probably find the actual ruling in my archived documents if you want to see it.

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What we had hoped to win was unrestricted PA practice ownership. What we ended up winning was stopping the board from making their rules retroactive thus taking away practices from long term PA practice owners. Texas is one of 6 or 7 states that still has a doctrine that prohibits anyone but a physician from owning a practice.

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It is a bit of a long story. PAs in Texas had plenty of work arounds to permit practice ownership and there were a couple of hundred PA owned practices in Texas. Some physicians in the valley didn't like competing with some PA owned practices so they made a complaint to the board. The board announced its intention to simply forbid physicians from working in PA owned practices. TAPA got involved and negotiated an agreement that forbade PAs from having more than 49% ownership of a practice. They considered this a good deal and touted it as a huge step forward in "officially allowing" PAs to own practices. It wasn't but that is another whole long story. Then the medical board wrote a rule stating practices currently owned by PAs would become subject to this rule if the physician supervisor changed. This , in essence, would take the practice away from the PA owner and/or force its sale. One physician down on the coast intentionally resigned as a physician supervisor in a PA owned practice and then bought the same practice in a fire sale. Myself and a group of PA practice owners (I don't own a practice. It is just a subject I have some passion for) created an organization called "The Physician Assistant Political Alliance" and sued the board in federal court. We attempted to have the whole thing over turned and had some success. The rule still stands but making the change retroactive in any way was found by the court to be improper. The ruling was upheld when the board/state appealed the decision. The cost to the group that financed this case was about $200k and , of course, we the taxpayers in Texas paid for the state to defend the board. I can probably find the actual ruling in my archived documents if you want to see it.

 

Thanks for taking the time to let me know- it's certainly frustrating to see PA practice ownership be curbed when it clearly works in other states.

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That's sad. I'd be interested in learning about the work arounds. If they still exist.

The deal TAPA signed off on is now law and the work arounds are pretty much dead and gone.

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I recently had a meeting with the driving force behind the law suit. It turns out the courts ruled against the board entirely. There is now a high court opinion against restricted practice ownership. There are plans afoot to have legislation passed in the next session to make state law match up with the court ruling.

In answer to a previous question about the 49% rule... prior to this deal being made and passed into legislation there were several type entities a PA could form or join to own a practice as evidenced by the 135+ PA owned practices that were subsequently enjoined by this latest legislation. The 49% rule came into being in the last legislative session.

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Late follow up.. after all the appeals and what not the federal courts essentially struck down restrictions on practice ownership in Texas. I now own my own practice (as of 2 weeks ago) and expect legislation in the next session to follow the federal court ruling. In the interim the medical board is no longer sending letters to practices asking them to declare their ownership.

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Oh wow that is a great development. Congrats. Hopefully this is only the beginning. Can this be used to do the same in other states? Precedence?

 

Sent from my SM-G925P using Tapatalk

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Sounds great, do you happen to know which court this case was in?  Just interested in looking for the ruling when it is published. Thanks for keeping us updated. 

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You guys should be given a medal.  From one PA in Dallas I say thank you.  That must of been a ton of work, and money.  Thank you, thank you, thank you.

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