Medicine Pushes Texas Medicaid to Help Save Primary Care
By Steve Levine


Leaders of the Texas Medical Association and four large primary care specialty societies on Wednesday painted for senior Medicaid officials the bleak fiscal picture of many physician practices, and requested immediate financial assistance.

They left the hour-long conference call with assurances that some good news will be coming soon for primary care practices ravaged by the COVID-19 pandemic.

The group, led by newly installed TMA President Diana L. Fite, MD, explained how reduced patient volume and revenues have placed patients and practices at risk. Empty waiting rooms, they said, mean children are missing developmental checkups and important vaccinations, and pregnant women are missing prenatal care.

Fear of contracting the virus is so high that some pregnant women have foregone prenatal care, with tragic outcomes, said Eugene Toy, MD, chair of the American College of Obstetricians and Gynecologists District XI (Texas). He told the Medicaid officials a story of two women who suffered severe, yet preventable complications.

“One of the women arrived at the emergency room with severe bleeding, but the physicians could not save her baby,” he said. “With early intervention, this death likely could have been prevented.”

Dr. Toy said he and his colleagues are worried that the COVID-19 crisis could increase Texas’ already-too-high maternal mortality rate.

Federal relief grants, accelerated Medicare payments, and small business loans have helped to fill the financial gap for some practices, the group explained. But practices with high volumes of Medicaid, Children’s Health Insurance Program (CHIP), and uninsured patients have waited in vain for federal aid to materialize.

The organizations’ wish list, to help “ensure the survival of the Medicaid physician network,” included:

  • Advanced Medicaid payments, retainer payments, or other financial supports directly from the state;
  • Vigorous action to encourage Medicaid managed care organizations to increase financial relief, such as prospective payment models;
  • Payment for well-child visits conducted via telemedicine; and
  • Extensive red tape relief, including reducing prior authorization requests and suspending Medicaid revalidation requirements.

In addition to Dr. Fite and Dr. Toy, medicine’s delegation included Tammy Camp, MD, president of the Texas Pediatric Society; Amanda LaViolette, MD, and Cynthia Jumper, MD, of the American College of Physicians, Texas Chapter; and representatives of the Texas Academy of Family Physicians. The state officials included Trey Wood, chief financial officer at the Health and Human Services Commission (HHSC), rate analysis director Victoria Grady, and Stephanie Stephens, Texas’ new Medicaid director.

Mr. Wood explained that federal guidance limits the state’s ability to make advanced or other financial payments except for the very small amount of Medicaid still paid for as fee-for-service. However, he said, Medicaid managed care plans can make such payments.

Additionally, HHSC staff noted that federal relief may be close at hand. Late last week, the Centers for Medicare & Medicaid Services (CMS) formally asked all 50 states for detailed data about physicians and providers who bill Medicaid, indicating that CMS appears finally to be preparing to make relief payments directly to physicians who participate in the program – as it has done for physicians who participate in Medicare. HHSC did not know when CMS might issue such payments.

Wednesday’s teleconference is just the latest in a long string of TMA and specialty society federal and state advocacy activities to rescue endangered practices. They include a nine-step plan to “Promote Accountable Care and Enhance Physician Practice Viability” presented to Gov. Greg Abbott last month, numerous visits with state and federal lawmakers, and most recently, a letter from Drs. Fite and Camp asking HHSC Acting Executive Commissioner Phil Wilson to approve prospective or retainer payments to pediatricians in Medicaid and CHIP, and to pursue federal funds to increase Medicaid physician payment rates to Medicare parity.

TMA also has created extensive tools and resources to help all physician practices reestablish or maintain their financial viability. They include:

As always, check the TMA COVID-19 Resource Center regularly for up-to-date news and the latest TMA materials for your practice.

Story revised May 8, 2020, to correct two errors in Dr. Toy’s quote. TMA regrets the errors.


Last Updated On

May 08, 2020

Originally Published On

May 07, 2020

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