aid money if they receive a reasonable payment to administer those drugs in their offices rather than in a hospital, which is more expensive.
Commissioner Suehs told the House Committee on Human Services that he continues to work with physician groups on other alternatives to alleviate the problem.
In April, HHSC announced that a
5-percent cut in payments for renal di- alysis services for dual eligibles would be applied only to payments to dialysis facilities and not to the physician com- ponent of dialysis services. An HHSC spokesperson said it was
“too soon to know if there will be addi- tional changes.” At the March town hall meeting, Mr. Millwee said there may be little else the agency can do about the copayment cuts without action from the Texas Leg- islature or from the Legislative Budget Board (LBB), which has some authority
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to adjust spending levels between legis- lative sessions. Ms. Kent Davis says that because of
the savings lawmakers expect to realize from the copayment and deductible cuts — some $475 million from physicians, hospitals, and other health care profes- sionals — HHSC can’t make significant changes without legislative approval. In addition to the rally and town hall meeting, TMA has launched a petition to convince the LBB to take action. As of early April, TMA had collected nearly 2,000 signatures on that petition. To sign it, log on to TMA’s website at www.tex
med.org/petition. Also, you can view a series of TMA-
produced videos on the dual-eligible is- sue by going to the Dual Eligibles page at
www.texmed.org/dual-eligibles (scan QR code below). Links to the individual videos can be found by clicking on the various articles on that page.
Kicked in the teeth While Dr. Cárdenas and others recognize that HHSC is trying to do what it can to mitigate the impact of the budget cuts, physicians on the front lines are frustrat- ed and say they don’t know how much longer they can keep their doors open. “I’m concerned for the 15 people who work in my office,” said Edinburg oph- thalmologist Imtiaz Mehkri, MD. “We’re getting kicked in the teeth.” Mission neurologist Gabriel Diaz, MD, added, “I don’t think we can survive to give care to patients with insurance or with no insurance.”
The most important thing now, Dr.
Cárdenas says, is getting some kind of timetable on when the LBB might act, so physicians can make plans for keeping their practices afloat. But political ob- servers say that was not likely to happen before the May 29 primary elec- tions. “We need some certainty,” Dr. Cárdenas said.
Scan this code with your smartphone for more information.
40 TEXAS MEDICINE June 2012
“And we can’t wait for the next legis- lative session. We need it now.”
Aetna deselecting 130 Texas physicians
Aetna has notified 130 Texas physicians it will terminate them from its networks on July 1, TMA’s Payment Advocacy Department has learned. Aetna says it told the physicians a year ago it was concerned about their billing patterns. Evaluation and management (E&M) codes were the only ones Aetna exam- ined, and its concern involves primarily levels 4 and 5 E&M codes.
Aetna says in letters to the deselected physicians that its data show their billing and coding practices caused them to be more costly than their peers.
TMA has developed a white paper on physicians’ basic rights and respon- sibilities in network terminations. It is not specific to Aetna; any physician de- selected by any health plan network can use it. To obtain a copy, contact the TMA Knowledge Center at (800) 880-7955 or email
knowledge@texmed.org. You can also download it from the TMA website at
www.texmed.org. Click on Practice Help, then Payer, then Health Plans. Fi- nally, under Contracts, look for Rights Upon Plan Termination. The 130 Texas physicians are among
doctors nationwide whom Aetna is re- moving from its networks. The action has sparked outrage by physicians. One physician posted the following com- ment on TMA’s Blogged Arteries (http://
bloggedarteries.texmed.org/?tw_ p=twt): “How does Aetna have the arro- gance to admit that these 130 docs cost them too much from their bottom line? What about the patients they’re leaving in the lurch? Anybody care about them?” Nationally, some of the outrage is
directed toward Aetna Chief Executive Officer Mark Bertolini. The Hartford Courant reported that one New Jersey physician, John Tedeschi, MD, posted a video on YouTube (
www.youtube.com/ watch?v=L6tf1z5Nss4) in which he said he tried contacting Mr. Bertolini, but was told he doesn’t speak to physicians. He says that he is amazed a physician
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