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Silent PPO legislation coming to a state near you

Expect the Texas legislature to pass laws tightly restricting PPOs before the end of the biennial legislative session June 1. According to WorkCompCentral, the Senate is making considerable progress on a compromise bill that will closely follow the NCOIL model.
The NCOIL model act includes strong disclosure requirements, standards for network contract and discount disclosure, penalties for PPO’s failure to disclose clients to providers, allows providers to refuse discounts taken without a contract and provides for enforcement under Texas’ unfair trade practices laws. (see the WorkCompCentral article for details)
This is good news for payers and providers alike.
Silent PPOs have long been a major bone of contention, leading to countless lawsuits and counter suits by payers and providers, tying up claims in seemingly endless litigation. Not only will the bill – if enacted – reduce legal hassles and the cost of same, I’m also hopeful that it will force payers to stop their endless, pointless, counter-productive discount-shopping.
Picking providers base on how much they’ll cut their rate is beyond dumb,for reasons laid out in detail elsewhere on this blog. Beyond that obvious problem is the damage that process dies to the payer-provider relationship. It tells the provider they are merely a vendor, a bill, a cost. It devalues their role entirely, transforming what is often an already-tense relationship into open warfare.
Payers have to treat providers intelligently, seek to understand their situation and motivations, and try to work with them. Sure some providers are crooks and frauds, but treating all of them as such just ensures claims will be contentious, difficult, and more costly.

Joe Paduda is the principal of Health Strategy Associates




A national consulting firm specializing in managed care for workers’ compensation, group health and auto, and health care cost containment. We serve insurers, employers and health care providers.



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