Saturday, May 4, 2013

First Repair for Broken Medicaid System? Better Payment

By Michael E. Speer, MD
President, Texas Medical Association

“A good builder knows you don’t construct an addition on a building with a cracked foundation.

“Throughout the state Capitol this spring, we’ve heard widespread talk about how the Texas Medicaid program is ‘broken.’ Texas physicians couldn’t agree more and cite bureaucratic red tape and below-cost patient-care payment rates as the main ‘cracks’ in the state’s Medicaid system.

“Last summer, the Texas Medical Association convened a Physicians Medicaid Congress to identify ways to stop hemorrhaging physician participation in the program. The congress received hundreds of ideas, many of them focused on streamlining Medicaid’s frustrating paperwork, and a call for providing real-cost patient-care payments. Thanks to strong support from state leaders, legislation is moving to reduce the red tape on Medicaid patient care, but no action is being taken on repairing the critical problem of below-cost compensation.

“Texas physicians are still being asked to lose money every time we care for a Medicaid patient. This forces most of us to limit the number of Medicaid patients we can see. That, in turn, makes it very difficult for a Medicaid patient to find a physician.

“The most recent TMA survey found that only 31 percent of Texas physicians accept all new Medicaid patients. That number has plummeted from almost 67 percent since the turn of the century.

“So, before the state and federal government expand the populations eligible for Medicaid, patient care rates need to be raised to cover the real cost of care. A good first step would be raising medical-care payment rates for Medicaid to the same level as Medicare.

“Make no mistake, physicians across the state provide care without compensation for low-income Texans every day. But like other businesses, we also have to pay staff, rent, and utilities.

“Like a rundown house in need of repair, you’ve got to pick up a hammer and start somewhere. Increasing Medicaid payment rates to cover physicians’ cost of providing care is the nail that needs to be hit first.”

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