Texas Health Resources, one of the private hospital partners, says it commit- ted to the full amount of funding that PAD and DCMS had requested. “We believe caring for the indigent should be a shared responsibility of all of the health care providers in Dallas County, and [PAD] is a good mechanism for making that happen,” spokesperson Wendell Watson said. “We’re committed to contributing our fair share, and we are concerned about the impact on the community if funding is inadequate. We will continue to work with physicians and other providers to resolve this issue and provide access to care.” Without other funding, for now, PAD has ceased new enrollments and reen- rollments of patients and will spend the next few months transitioning current patients into new medical homes and helping them find new sources of medi- cation as needed.
man Services Commission (HHSC) to re- instate some of that coverage beginning this year.
The move came in response to ongo- ing advocacy efforts by the Texas Medi- cal Association to reverse the payment reductions that the 2011 Legislature in- stituted to help plug a $27 billion budget hole at the time. Physicians protested that the state’s
Dual-eligible payment cut partially restored
Physicians will begin seeing partial restoration of last legislative session’s payment cut for treating dually eligible Medicare and Medicaid patients, af- ter the Texas Legislative Budget Board (LBB) directed the state Health and Hu-
sickest and most vulnerable patients — seniors, the poor, and the disabled — were the ones paying the price for the money-saving maneuver. The cut hit many physician practices hard, particu- larly those in rural and border areas where doctors serving a disproportion- ate number of these patients had to drop out of Medicaid, lay off staff, or borrow money to keep running their practices, if not close their doors altogether. Lawmakers had directed HHSC to limit payment for these patients’ servic- es to the Medicaid allowable, meaning that if Medicare paid more for a service, which is almost always the case, the state would not pay any more. Before the change, which HHSC im- plemented on Jan. 1, 2012, Medicare paid 80 percent of a dual-eligible pa- tient’s visit to a doctor; Texas Medicaid paid the remaining 20 percent of the cost and covered the Medicare deduct- ible for these patients.
The LBB decision means that HHSC
will restore Medicaid coverage of the $147 annual Medicare deductible for 2013. At press time, the agency had not
yet laid out a date or details for imple- mentation of the change. The payment likely will be retroac- tive to Jan. 1 to cover physicians for the whole year, TMA Director of Govern- mental Affairs Helen Kent Davis says. The move is a good first step, she says. But TMA will continue to advocate for full restoration of the 20 percent coinsur- ance payment. Physicians who see large numbers of dually eligible patients take that hit at each visit. And if patients see multiple physicians, the doctors typically split the Medicare deductible. Reinstating some or all of the coinsur- ance, however, will require the legisla- ture to act via the budget process, Ms. Davis says.
The issue is expected to spark debate this session and remains a top priority for TMA’s Physicians Medicaid Congress. The group met in December to finalize its legislative and regulatory proposals for reforming the program to present to state leaders.
Kelsey-Seybold receives ACO accreditation
After growing to one of Houston’s larger multispecialty group practices over the past decade, Kelsey-Seybold Clinic al- ready considered itself a model of co- ordinated, accountable care, Chair and Managing Director Spencer R. Berth- elsen, MD, says.
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The National Committee for Quality Assurance (NCQA) recently confirmed that assumption when it named the phy- sician-owned clinic an accountable care organization (ACO) in December. “The country is undergoing a transfor- mation in the way health care is deliv- ered toward more accountable systems of care,” Dr. Berthelsen said. “This desig- nation serves as a guidepost to patients and others who depend on us — em- ployers, payers — so they know they are receiving care that fits the full model of an ACO.” NCQA’s new ACO accreditation pro-
46 TEXAS MEDICINE February 2013
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