Who this touches

Who	What changes for them
Patients	Gain the right to know who is treating them, to ask for a physician, to see who owns their doctor's practice, and to sue if a corporate arrangement harmed them.
Physicians	Regain final say over medical and staffing decisions, keep the fees they earn, choose their own medical directors, can staff an ER regardless of specialty at equal pay for equal work, can leave a bad arrangement without a noncompete, vote each year on the executive bonus plan (Sec. 166.356(d)), and can refuse an unsafe surgery or admission without losing their job or privileges.
Doctor-owned practices and groups	Largely unaffected. Can still use a management company for back-office work. Become the only kind of group eligible to hold a hospital coverage contract.
Management companies (MSOs)	Must give up any ownership, profit share, or control over clinical and staffing decisions by the transition date, and register their contracts with the Medical Board.
Private equity firms	May lend, lease, and sell services. May no longer own or control physician practices or hold hospital department contracts in Texas.
Hospitals, freestanding ERs, surgery centers	Must contract directly with doctors or doctor-owned groups, keep a physician on site in the ER, give the medical staff notice before cancelling a department contract, and post who provides their ER physicians.
Hospital executives and administrators	May not override a doctor who declines an unsafe case or retaliate against him or her (Sec. 166.059). Bonuses can no longer be tied to patient volume, physician cuts, the ER group’s subsidy, or billing, and each year’s bonus plan is void unless the medical staff ratifies it by secret ballot; the plan, the vote, and the bonuses paid are posted by the state (Sec. 166.356(d)). Knowing violations can be prosecuted as the unlicensed practice of medicine, a felony (Sec. 166.257).
Texas Medical Board	Registers management agreements, posts ownership, takes complaints, subpoenas records, and disciplines physicians who front for illegal arrangements.
Attorney General and HHSC	The AG enforces against companies that are not licensed physicians. HHSC enforces the hospital-contract rules through facility licensing.