“To expand the program without fixing what’s wrong with the infrastructure would not be the right course.”
Texas physicians are forced to severely limit the number of Medicaid patients they can see. This forces many Texas Medicaid patients to forgo normal medi- cal care in a doctor’s office and to over- utilize expensive emergency department care,” he said.
That’s why doctors say equalizing Medicaid payment rates to the same lev- els as Medicare is a key reform that must precede any expansion of Medicaid in Texas. The long-standing issue of Med- icaid payment reform is such an obvious one that the Medicaid Congress’ report did not spend too much time discussing it, Dr. Holcomb added. The congress’ list also encompassed
Medicaid coverage to more of the state’s uninsured, namely low-income parents and childless adults. The Texas Hospital Association, the
Texas Association of Community Health Centers, and other advocacy, faith-based, and business groups have also endorsed expansion. Texas could draw down $100 bil- lion in federal funding over 10 years to match $15 billion in state money, ac- cording to a report by Billy Hamilton, the state’s former deputy comptroller and now consultant.
“That money could go a long way to help underserved populations in every area of the state. But none of that can happen without viable physician practic- es delivering care, and given the present trajectory, I can tell you that viability is stressed,” said Dr. Cardenas, vice presi- dent of the TMA Board of Trustees. “To expand the program without fix- ing what’s wrong with the infrastruc-
ture would not be the right course. So we think the approach we are taking is a measured approach that moves us in the right direction and is right for our patients,” he said.
On top of the fiscal benefits, TMA leaders also highlighted the medical benefits of expanding Medicaid coverage. “There is undisputable evidence in
the peer review literature that kids and adults with insurance, even public insur- ance, do better in health care outcomes over a period of years,” said John Hol- comb, MD. The San Antonio pulmonolo- gist cochairs the Medicaid Congress and leads TMA’s Select Committee on Medic- aid, CHIP, and the Uninsured.
Douglas Curran, MD John Holcomb, MD 28 TEXAS MEDICINE April 2013
The fix-it list Finding a way for Texas to expand Med- icaid coverage is among more than 100 different recommendations the Medicaid Congress researched and developed with input from diverse physician specialties and geographic regions across Texas. Raising Medicaid rates to cover the cost of care, reducing administrative hassles, and ridding unfair and unnec- essary regulatory burdens also would go a long way toward improving access to care. Those steps are critical before ex- pansion can be considered, TMA Presi- dent Michael E. Speer, MD, says. “Because Medicaid patient-care rates are often below the actual cost of care,
everything from reversing the dual-eligi- ble payment cuts and ensuring fair fraud and abuse investigations, to promoting improvements in care delivery and ben- efits coverage.
Among other solutions:
• Standardize Medicaid HMO prior au- thorization forms,
• Maintain a single statewide preferred drug formulary,
• Recognize all billing modifiers used by Medicare and commercial insurers,
• Promote physician-led accountable care organizations (ACOs),
• Pay physicians for after-hours services, • Develop strategies to reduce patient no-show rates,
• Improve data sharing among prima- ry care physicians, specialists, and health plans, and
• Enhance enforcement of HMO net- work adequacy.
“I checked, and Medicaid’s rulebook is now 1,800 pages long” and filled with red tape, Dr. Holcomb said.
He also noted a connection between
the low Texas Medicaid payment rates — which stand at just 78 percent of Medi- care pay on average — and the decline in physician participation rates. In 2000, 67 percent of Texas physicians accepted all new Medicaid patients, compared with 31 percent in 2012, according to TMA surveys. (See “Texas Physicians Who Accept All New Medicaid Patients,” opposite page.) That’s why bolstering payments, espe-
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68