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LEGISLATIVE AFFAIRS


Fix it first Medicaid Congress recommends reform, expansion


BY AMY LYNN SORREL Every time Edinburg gastroenter- ologist Carlos J. Cardenas, MD, needs preapproval for treatment or medication for a Medicaid patient, he and his staff spend at least 20 minutes on the phone. Multiply that by several patients a day and multiple HMOs — each with a differ- ent process — and the time spent away from patient care adds up. Every time a patient eligible for Medicare and Medicaid goes to see Ath- ens family physician Doug- las Curran, MD, he takes a 20-percent pay cut because the state no longer covers the Medicare copayment for those poor, senior, or disabled patients. Multiply that by more than 300,000 dual-eligible patients across the state that doctors still see so their complicated ill- nesses don’t go untreated, and the amount of money lost to physician practices adds up. With every simple mis-


Those burdens and


take on a Medicaid billing form, physicians like Alex Kenton, MD, a neonatolo- gist in San Antonio, worry about state authorities accusing them of fraud. If he takes on a high volume of Medicaid pa- tients, the chances of becoming a target appear to add up. And every year Medicaid payments to Texas physicians con- tinue to fall below the cost of care, fewer physicians can afford to treat those patients.


Gastroenterologist Carlos J. Cardenas, MD, spends a lot of time on the phone grappling with Medicaid HMOs — time better spent on patient care. Those kinds of hassles, he says, keep doctors away from the Med- icaid program.


scores more prompted TMA’s Medicaid Congress to develop a thorough fix-it list for Texas leaders, one that physicians say holds the keys to strength- ening the ailing program and attracting doctors back to it. Doctors hope the rec- ommendations will fac- tor into the many Medic- aid discussions expected to take center stage this legislative session and beyond. The program already is the subject of several bills that aim to save money by expanding Medicaid managed care, adding quality-based pay- ment initiatives, and fight- ing fraud. Also, pressure mounts on state lawmakers to snag billions of federal dollars available under the Patient Protection and Affordable Care Act (PPACA) to expand the Medicaid program. Some legislators appear to en- tertain the idea despite staunch opposition from Gov. Rick Perry to grow


the Medicaid program as prescribed by the federal health sys- tem reform law. Part of that pressure now comes from physicians. The reform recommendations by the Medicaid Congress are a critical component of a TMA Board of Trustees resolution of- fering support for a bipartisan, flexible approach to expanding


April 2013 TEXAS MEDICINE 27


JODY HORTON


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