Feb. 3, 2015
Texas Medicaid is
at a tipping point, Texas physicians said today. “Either it can continue on its
current path pushing physicians out of the program, or it can make needed
changes that will improve patients’ access to care and save taxpayers money,”
said Texas Medical Association (TMA) President Austin I. King, MD.
“The state must
take steps to reduce the red tape and administrative hassles that detract from
our ability to provide needed care, drive up overhead costs, and ultimately
make the meager Medicaid payments too low for many physicians to put up with
the morass,” he said.
state leaders asked for big changes to ensure low-income patients receive
care in the most efficient manner. “The best place to provide care to Medicaid
patients is in our practices — not in expensive emergency departments,” said
Dr. King. “Texas has the power to make needed changes.
spends money. The question is: Are we spending it wisely?” asked Dr. King.
hired Medicaid HMOs to ensure patients had cost-effective care coordination by
physicians, specialists, and subspecialists, but that is not playing out across
many communities in Texas.
find Medicaid HMOs too burdensome, too slow, and too complicated. “They only
drive up costs,” said Douglas W. Curran, MD, an Athens family physician and
member of TMA’s Board of Trustees, who had to keep a child in the hospital for
several days while he waited for a Medicaid HMO to approve an in-home inhaler
that costs less than $100.
“Then just last
week I spent three hours on the phone with a Medicaid HMO trying to get a generic
prescription approved for my elderly patient after surgery. I talked to three
different people, and not one of them could help — that costs my staff and me
time and money, and delays care for my patient,” explained Dr. Curran.
neonatologist Michael L. Battista, MD, said he can’t find a pediatrician or
subspecialist to take care of his infant patients once they leave the neonatal
intensive care unit. “These babies end up in the emergency department a few
weeks later with complications. Care coordination is desperately needed. It
would help save millions of dollars,” said Dr. Battista.
For more than a
decade, physician Medicaid participation rates have been in a free fall,
plummeting 33 points in 14 years. In 2000, 67 percent of Texas physicians
reported accepting all new Medicaid patients; by 2012, only 34 percent did,
according to TMA surveys.
easily decide not to see Medicaid patients. “We want to provide prenatal care
to pregnant women, medications for asthmatic children, and community services
for seniors wishing to stay in their homes instead of a nursing facility”
explained Luis Benavides, MD, vice chair of the Border Health Caucus and a
Laredo family physician.
Not only do
physicians want to care for these patients but also many have tried
unsuccessfully to enroll to do so. “It took months to get a Medicaid number for
new physicians in my practice so they could take care of Medicaid patients and
get paid for it,” said Dr. Curran. “After six months of calling, I finally called
the Health and Human Services commissioner myself — and a few days later the
problem was solved. I was lucky. I had access to the top, but not everyone
does. One physician group in Athens waited more than a year to get its newly
recruited physician Medicaid credentialed. That’s just wrong.”
“We found that it
doesn’t take much to incentivize physicians to stay in the program,” said Dr.
King. The Affordable Care Act increased Medicaid payments to Medicare rates for
eligible primary care physicians for the past two years. According to TMA’s
2014 physician survey, for the first time since the 2007 Frew lawsuit, physicians’
participation in Medicaid increased — to 37 percent. The payment incentive now
“I guarantee you
the numbers will drop unless Texas keeps those primary care payment rates
going,” Dr. King said. “Better yet would be to extend them to all physicians
and all services.”
To accomplish TMA’s
goal of improving Medicaid patients’ access to physicians care while saving
tax dollars, the association is asking lawmakers to take these six steps:
- Improve physicians’ Medicaid payments;
- Cut Medicaid red tape and administrative hassles;
- Hold Medicaid HMOs accountable for establishing adequate physician
networks to care for patients;
- Restore funding for Medicaid-Medicare “dual-eligible” patients;
- Stop unfair and unreasonable fraud and abuse audits; and
- Find a creative solution to pull down federal dollars to ensure
working poor adults have access to health care.
These six steps are
outlined in TMA’s
Healthy Vision 2020
Second Edition: Caring for Patients in a Time of Change.
“The state is
trying to balance the budget on the backs of physicians, and our backs are
breaking. We can’t take it anymore,” said Dr. King. “We need a plan not just
for the present but also for patient care of the future.”
TMA is the
largest state medical society in the nation, representing more than 48,000
physician and medical student members. It is located in Austin and has 110
component county medical societies around the state. TMA’s key objective since
1853 is to improve the health of all Texans.
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Contact: Pam Udall
phone: (512) 370-1382
cell: (512) 413-6807
phone: (512) 370-1381
cell: (512) 656-7320
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