Texas physicians are losing money during the pandemic. They want lawmakers to make health insurers pay up.

A family physician trade group wants state lawmakers to reform how insurance companies pay their practices. It says the coronavirus pandemic has created financial problems that could cause many physicians to close their offices. Credit: Martin do Nascimento for the Texas Tribune

Texas primary care doctors say they’re hemorrhaging cash and at risk of closing their doors during the coronavirus pandemic, and a new trade group proposal argues it’s time for Texas lawmakers to overhaul how physicians’ practices get paid.

More patients are forgoing office visits as they stay home to avoid the virus, and doctors’ offices report that their revenues have fallen sharply as a result. Many large health insurance companies have posted huge profits during the same period.

A family physician trade group wants insurers to share the wealth, and with four months before the 2021 legislative session is scheduled to begin, they’re asking state lawmakers for help. The Texas Academy of Family Physicians calls its proposal a “Primary Care Marshall Plan,” a reference to the massive program of U.S. investment to help parts of Europe rebuild after World War II.

“Just as the aftermath of war offers an opportunity to rebuild, the devastation COVID-19 wrought on our health care system and our economy gives us the opportunity to rebuild a better, more cost-effective system of care,” the proposal says.

The physician group, which represents nearly 10,000 members, is also asking for other reforms, such as new state laws to make it easier for physicians to get paid for seeing patients via telemedicine. It’s calling on the Texas Legislature to expand the Medicaid public insurance program to cover poor adults, which would lower the state’s uniquely high uninsured rate and increase the number of paying customers at doctors’ offices. And it wants lawmakers to restore funding to a program that studied health disparities among racial groups until it was defunded in 2017.

But payment reform is their No. 1 demand, with the proposal calling for state-governed health plans to move away from the traditional “fee-for-service” payment model. Under that system, the mainstream in American medicine, physicians bill insurance companies based on each discrete service they provide, such as an office visit, lab test or immunization.

The doctors instead want insurance companies to embrace a “prospective payment” model, in which insurers pay physicians a set fee per patient each month, akin to a subscription service.

Those changes are necessary to keep primary care physicians’ offices afloat, doctors say.