“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.
Texas physicians today asked 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.
“Texas Medicaid spends money. The question is: Are we spending it wisely?” asked Dr. King.
The government 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.
Many physicians 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.
San Antonio 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.
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 a
nd 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 has expired.
“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.”