BHC Ask Senate Finance Committee to Restore Dual Eligible Cuts

TMA/BHC Testimony by Hector Trevino, MD

Article II, Health and Human Services Commission
Thurs., Jan. 31, 2013

Good afternoon. I am Hector Trevino, MD, a family physician from Eagle Pass. I am speaking today on behalf of the Texas Medical Association, Texas Academy of Family Physicians, and the Border Health Caucus (BHC), a confederation of county medical societies that work together to improve patient care and public health throughout South Texas.

Thank you for the opportunity to testify and for your service. We appreciate what a juggling act you face in crafting a compassionate and balanced budget for a growing state, all while judiciously allocating taxpayer dollars. Our organizations stand ready to work with you to achieve our mutual goals to improve the health of all Texans.

I am here today to respectfully urge that one of your utmost priorities be to reverse the 20- percent physician payment reduction for physicians who care for patients known as dual eligibles. The unintended consequence of the cut has been financial ruin for many physician practices across the state.

Dual eligible patients are low-income seniors and people with disabilities who qualify for both Medicare and Medicaid. Roughly half of duals suffer from multiple chronic conditions, including mental illness, and many are unable to perform tasks of daily living on their own. They are some of the sickest and frailest patients in the state.

All Medicare patients, including duals, are subject to cost-sharing. Patients must pay an annual deductible and 20 percent coinsurance on most medical services. Dually eligible patients are too poor to pay these costs on their own, thus Medicaid pays the cost-sharing on their behalf.

Under the two-part policy enacted last January, Texas Medicaid:

1) discontinued paying the entire portion of the patient’s Medicare deductible ($147 in 2013); and
2) stopped paying the patient’s coinsurance if Medicare’s payment to the physician exceeded what Medicaid pays for the same service, which is almost always the case. (see example)

Just a few days ago, the state did restore payment of the deductible payment, a tremendous relief to those practices financially struggling since enactment of the cut. Many of you on the committee fought hard to restore the deductible and I sincerely thank you for your help.

However, the continued coinsurance reduction means every time I see a dual eligible patient there is a 20-percent payment cut, an unsustainable and devastating financial blow.

In Eagle Pass, as in other underserved communities, it is not an option for me to limit or stop seeing these patients, many of whom have been with me for decades and would have no other place to go for medical care if I stopped seeing them.

While I struggle on, the cuts are negatively affecting patient care. At least one hospital in the Valley indicates that it is seeing a higher frequency of emergency department visits among dual eligibles because these patients cannot obtain office appointments with a physician. Several border and rural hospitals also indicate that the payment reduction is undermining their efforts to recruit new physicians to their communities. An insufficient physician supply will affect the medical care of the entire community, not just duals.

Maintenance of this policy also penalizes the physicians who care for the sickest and frailest Medicare patients, though the state needs these same physicians as partners in efforts to reduce potentially preventable events and promote better care coordination to reduce Medicaid costs.

It is not an exaggeration to say many physician practices are hanging by a thread as a result of the cut. Without restoration of the coinsurance, my practice, and thousands like it, will not survive much longer.

I urge your swift consideration.

Here’s an example of how the current policy works:

An established dual-eligible patient visits her physician office for a routine examination. The 2013 Medicare deductible has been met. The physician bills Medicare for the service. The Medicare allowable payment is $72.44. Medicare will pay the physician $57.95, 80 percent of the allowable. The patient is then responsible for the remaining $14.49 (20 percent). For a dual eligible, the physician bills Medicaid for the balance.

The Medicaid allowable for the same service is $33.27. Because the Medicare payment exceeded the Medicaid allowable, Texas will not pay any additional amount. The physician must write off the $14.49.

83rd Texas Legislature Letters and Testimonies main page  

Dual-Eligibles main page 

Legislature main page 

Last Updated On

January 06, 2020

Related Content

Dual eligible