Don't Cut APRNs and PAs Medicaid Payments

TMA Testimony by Doug Curran, MD 

Against Senate Bill 682 by Sen. Donna Campbell, MD 
April 2, 2013
 

Madam Chair, members of the committee, I am Doug Curran, a family physician in Athens, Texas and member of TMA’s Trustees. I’m here today to testify against Senate Bill 682 on behalf of the Texas Medical Association and Texas Academy of Family Physicians.

We generally agree with a portion of SB 682 which, as we understand the intent, is for the Health and Human Services Commission (HHSC) to consider rules to require the name of the practitioner providing the service and their national provider identification (NPI) to be included on any claim for reimbursement. We can see merit in this approach as it would help the state to know and understand who is providing services to our Medicaid enrollees. At the same time, even in the absence of legislation, it is always the  prerogative of HHSC to convene a stakeholder group for these discussions.

SB 682 would direct HHSC to write rules to generally reimburse an Advanced Practice Registered Nurse (APRN) or Physician Assistant (PA) at 92 percent of the physician rate.

Currently, HHSC allows services performed by an APRN or PA to be reimbursed 100 percent of the physician rate if those medical acts are delegated by a physician to qualified and properly trained persons acting under a physician’s supervision.

There is good reason to allow the continuation of the 100 percent rate. The 8 percent differential is not just for chart review, it also recognizes the physician's supervision, active and efficient collaboration, and the physician being constantly available for those patients who specifically need the physician's care. Unfortunately, there is not a CPT code a physician can utilize to capture this cost.

So while the process itself may be worthy of review, the policy of cutting payments runs counter to the efficiencies of team care and the concept of a patient centered medical home.

At the same time, we are concerned the net effect of this proposed change would be a cut in payments to the many practices that are doing precisely what they should be doing - working with other professionals in a team based practice, providing excellent patient care, with each practicing up to their education and licensure. This is the very approach we have encouraged through our support of Sen. Jane Nelson's Senate Bill 406.  This bill introduces a very significant disincentive for these arrangements.

We are concerned that in the whole, such a change - an 8 percent reduction in already low Medicaid payments -  would serve to drive more physicians, APRNs and PAs from the Medicaid program at a time we desperately need them in the program.

Thank you for your time. I would be happy to entertain any questions.
 

83rd Texas Legislature Letters and Testimonies main page 


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