For Angela Moemeka, MD, COVID-19 was a rude welcome to a nascent solo practice.
The Coppell pediatrician opened her one-doc shop, Mark9 Pediatrics, in November. Now, nearly six months and one sweeping pandemic later, she’s in the same boat as many of her fellow pediatricians: Patient volume is down, and the future is frighteningly uncertain.
“We’re a baby practice,” she said. “A baby practice needs a lot of TLC, and right now, the pandemic has been very challenging to continue to give it what it needs to grow.”
But in the view of Dr. Moemeka and other members of the Texas Pediatric Society (TPS), not much TLC has come from the state or federal governments, either. As those governments distribute funds and waivers to help health care workers during the pandemic, Texas pediatricians feel their needs have been unmet.
The Texas Medical Association, TPS, and other physician groups are advocating for pediatricians. They want Austin and Washington to address their concerns about having the proper tools to care for patients during COVID-19 – and about keeping their doors open.
The first round of funding from the federal CARES Act’s Provider Relief Fund focused on helping practitioners who treat Medicare patients, which essentially shut pediatricians out of that $30 billion. Without that funding source, small-practice pediatricians like Dr. Moemeka and Frisco’s Seth Kaplan, MD, had to make do with loans from other avenues, like the Small Business Administration’s Paycheck Protection Program (PPP), to address their immediate cash-flow problems.
“Even though it was unintentional,” Dr. Moemeka said, “it did feel like a slap in the face to see public health funding and relief for everyone except pediatricians, who have without question been taking care of the most vulnerable population in the state.”
At a White House press briefing earlier this month, Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma said the second tranche of funding would include funds for pediatricians and others who get their revenue from non-Medicare sources. TMA has asked the government for more details on the distribution for that tranche, which totals $70 billion.
Meanwhile, at the state level, pediatricians feel hamstrung as emergency rules relaxing telemedicine regulations haven’t yet allowed well-child visits in the Medicaid Texas Health Steps program to occur through that technology. In a March 30 letter, TPS and TMA asked the Texas Health and Human Services Commission (HHSC) to allow telemedicine for those visits during the public health emergency.
“Preventive care is a big part of what we do in pediatrics, and a lot of that care can be handled effectively through telemedicine,” said Louis Appel, MD, chief medical officer and director of pediatrics at People’s Community Clinic in Austin. “Well-child checks are the main type of preventive visit we do. And to the extent that that’s not being allowed yet through telemedicine, it is leaving a really big gap in the care of children in Texas, but also a gap in the support to the practices of physicians in Texas, pediatricians in particular, who provide that care.”
HHSC told Texas Medicine in an email: “Although telemedicine well-checks are not currently an option for children participating in the Texas Health Steps program, it is an item we are working on to ensure families can continue visiting doctors to keep their children healthy.”
In an April 13 letter to Gov. Greg Abbott, TMA and 29 specialty societies asked the governor to implement a “Multi-Point Plan to Promote Accountable Care and Enhance Physician Practice Viability.” Among the pieces of that proposed plan: direct Medicaid to implement advanced payments for physicians, similar to Medicare’s, to provide reliable cash flow.
The groups also asked the governor to direct Medicaid and state-regulated health plans to temporarily authorize the use of telemedicine for well-child visits, as well as to suspend prior authorization requirements. Also, TMA has been working with the American Medical Association to identify additional federal Medicaid relief in the next coronavirus relief bill, including seeking additional dollars for Medicaid physician payments and protecting Medicaid and the Children’s Health Insurance Program (CHIP) from cuts in eligibility.
Dr. Kaplan, who’s been in independent practice in Frisco for 20 years, was already dealing with the realities of an aging patient population and thinner margins. He said his practice, TLC Pediatrics of Frisco, was already in a tenuous position before COVID-19.
“This all went down around the time our local schools were on spring break, so our volumes were already going to be down a little bit … and then our volumes just plummeted soon after that, as everything started to happen and people started to socially distance and stay at home,” he said.
With a PPP loan his practice recently secured, “we’re going to be OK for the next two months.” Beyond that, the future is unclear.
“[Pediatricians are] doing everything we can on our part to try to keep kids away from ERs and away from urgent cares as much as possible,” Dr. Kaplan said. “But it does definitely feel like we’ve been overlooked.”