Dual-Eligibles Cut Partially Restored
After months of TMA-organized rallies, lobbying, and meetings, the Legislative Budget Board directed the Texas Health and Human Services Commission (HHSC) to restore part of the cut in payments for patients covered by both Medicare and Medicaid.
The tipping point was a meeting State Sen. Juan "Chuy" Hinojosa (D-McAllen) organized at the Capitol last week with Lt. Gov. David Dewhurst and House Speaker Joe Straus. The group included TMA Board of Trustees Vice Chair Carlos Cardenas, MD, of Edinburg, and La Joya family physician Javier Saenz, MD. Although Gov. Rick Perry did not attend the meeting, his support helped move the change over the finish line.
"It's a great first step," said TMA President Michael E. Speer, MD. "Physicians across the state and their patients have been reeling from the impact of these cuts for almost a year. We definitely needed a reprieve. Since January, it's been a true medical emergency. Physicians who care for Texas' most sick and most vulnerable patients have had to borrow money to keep their doors open, lay off staff – some dropped out of the Medicaid program, and some did close their practices."
The 2011 Texas Legislature ordered the cut in dual-eligible payments as a budget-saving move. The way HHSC implemented it covered two pieces of the complex interaction between Medicare and Medicaid payments to physicians. The change effectively:
- Stopped Medicaid from covering all of the dual-eligible patients' $140 annual Medicare deductible; and
- Prevented Medicaid from paying more than the Medicaid-allowable charge; this stopped Medicaid coverage of the Medicare copay.
The agreement reached would reinstate coverage of the Medicare deductible in 2013. Exact details of how HHSC would implement that change were still being worked out as this issue of Action was prepared. TMA will keep you informed as we learn more.
South Texas physicians praised Senator Hinojosa, state Rep. Richard Raymond (D-Laredo), state leaders, TMA, and HHSC officials for reaching agreement on the deductibles issue.
"This was indeed a team effort from the rallies we have had here on the border and in countless meetings in Austin," Hidalgo-Starr County Medical Society President Victor Gonzalez, MD, told the Rio Grande Guardian. "Chairman Raymond and Senator Hinojosa and all our elected officials were so helpful and supportive."
Reversing the cut is one of the top priorities identified by TMA's Physicians Medicaid Congress. Dr. Speer said TMA will continue to pressure lawmakers when the legislature convenes in January to restore the remainder of the cut.
"We now urge lawmakers to eliminate the rest of this cut as soon as possible," he said. "While this cut has disproportionately impacted dual-eligible patients with disabilities and seniors, when physicians are forced to close their doors or reduce services, it affects all of our patients."
State Delays Medicaid Fee Increase
The Texas Health and Human Services Commission postponed the Medicaid primary care physician payment increase authorized under the Patient Protection and Affordable Care Act. The law requires states to increase Medicaid payments to Medicare parity for primary care services provided by pediatricians, family physicians, and general internists from Jan. 1, 2013, to Dec. 31, 2014. The federal government will pay the higher costs.
The Centers for Medicare & Medicaid Services (CMS) did not publish final rules implementing the rate increase until Nov. 1, leaving states scrambling to interpret the implementation requirements and to make the necessary system changes, said Helen Kent Davis, director of government affairs for the Texas Medical Association. By late November, it was clear that there were too many outstanding technical issues to be resolved for Texas and other states to start paying the higher rates by Jan. 1, she said.
Regardless when the change does take effect, the state will make retroactive payments for eligible services to Jan. 1 to ensure eligible primary care physicians receive two years of higher payments, Ms. Davis said.
The higher payments will apply to evaluation and management and vaccine administration codes and will benefit physicians who participate in both Medicaid fee-for-service and Medicaid HMO plans, she said. Further, the federal rule specifies that physicians who are pediatric, family medicine, or internal medicine subspecialists also will be eligible for higher payments. Payments for eligible services provided by physician assistants or advanced practice nurses also will increase if patients receive the service under physician supervision. If midlevel providers bill under their own Medicaid numbers, they will be paid 92 percent of the higher rate, the same discount that applies to their services today. Eligible physicians will be required to self-attest that they qualify for the higher payments. Details about the attestation process are not yet available.
In a related issue, TMA President Michael Speer, MD, said in a letter to the Texas congressional delegation that Congress should not reverse CMS plans for the Medicaid physician payment increase to pay for preventing drastic cuts in Medicare payments to physicians. The presidents of the Texas Academy of Family Physicians, the Texas Pediatric Society, and the American College of Physicians-Texas Chapter also signed the letter.
Reversal of the pay hike for Medicaid primary care services is one proposal to pay for stopping the 27-percent cut in Medicare payments scheduled to take effect Jan. 1.
"We cannot turn Medicaid into a more effective delivery system until we shore up Medicaid patients' eroding access to primary care physicians and key specialists," Dr. Speer wrote. "Only 31 percent of Texas physicians now accept all new Medicaid patients, according to a recent TMA survey, and poor payment is the primary culprit. CMS recognized this when it acted to boost Medicaid payments for eligible physician services. Reversing this solution for short-term savings – even if those savings might be used to fix Medicare's glaring payment problems – will ultimately cost lives and more money."
The American Medical Association and national and state medical and specialty societies across the country, including TMA, also wrote congressional leaders to oppose the cut. "The Medicaid payment increase is an important policy that attempts to better align payment rates with cost of care for primary care physicians, thus increasing access to primary care physicians for millions of Medicaid patients," that letter said.
Medicine: Don't Jump Off Fiscal Cliff
Congress should pass "a fiscally responsible, bipartisan agreement" to stop budget cuts that would devastate health programs if the federal government goes over the so-called "fiscal cliff" at the end of the year. That message was delivered in letters to House and Senate leaders of both political parties by TMA, the American Medical Association, and medical societies across the country.
The groups said the across-the-board budget sequestration cuts scheduled to take effect Dec. 31 "would endanger critical programs related to medical research, public health, workforce, food and drug safety, and health care for military families, as well as trigger cuts in Medicare payments to physicians and graduate medical education programs that will endanger patient access to care. While we acknowledge and support the need to reduce our nation's burgeoning budget deficit to a fiscally sound level, we believe that the arbitrary and formulaic sequestration approach is not the appropriate policy to attain our nation's long-term health care goals. Congress should take a more targeted, rational approach that allows careful assessment of how to fulfill its long-term commitment to seniors, uniformed service members and their families, and public health and safety priorities."
The letters called for eliminating the Sustainable Growth Rate formula that threatens a 26.5-percent cut in Medicare payments to physicians on Dec. 31 and preserving existing Medicare payments for graduate medical education and funding for key research, public health, and prevention programs.
TMA and the others urged Congress "to consider the long-term benefits of maintaining funding for programs that are essential to achieving our nation's goal to reform the Medicare payment and delivery system, improve public health and safety, improve access to health care services, and reduce overall health care costs."
The letters stem from a resolution cosponsored by the Texas delegation and approved by the AMA House of Delegates at its meeting in November.
Tell Congress to Kill the SGR Zombie
We need your help to convince Congress to stop the "zombie Medicare financing" it uses to pay physicians. Every year for the past 12, cuts driven by the defective Sustainable Growth Rate (SGR) formula have come back from the dead … but in even worse shape. The SGR crisis is not dead nor does it lie dormant. It's very much alive.
Year after year of payment uncertainty is forcing doctors out of Medicare, making it more difficult for seniors, Texans with disabilities, and military families to get the care they need. In fact, the number of Texas physicians accepting all new Medicare patients dropped from 78 percent in 2000 to only 58 percent in 2012. This statistic is frightening. The crisis can only get worse as millions of baby boomers become of Medicare age.
Please call Washington at 7 am every Tuesday until Congress stops the payment cut and agrees to fix the defective SGR. Join your colleagues to convince Congress to stop this year's 27.5-percent cut. Get commitments from Sens. John Cornyn and Kay Bailey Hutchison and your representative to fix the 12-year-old problem.
For talking points and congressional phone numbers, go to the Medicare Meltdown Action Center.