HHSC programs, including CHIP and Children with Special Health Care Needs. Doctors also recommended that
HHSC expand the increase to include obstetrician-gynecologists and other primary care physicians, as well as sub- specialists, serving Medicaid and other HHSC patients. Forthcoming proposed federal rules may apply related PPACA provisions to subspecialists affiliated with just pediatrics, family medicine, and general internal medicine. Still, others could be left out, and pri-
mary care physicians cannot effectively care for patients without a complemen- tary network of subspecialists — a com- monly cited reason for primary care doc- tors limiting or discontinuing Medicaid participation, the groups said. “The physician Medicaid network is
in a free fall, with barely a third of phy- sicians accepting all new Medicaid pa- tients,” they cautioned. “Our organiza- tions cannot emphasize enough that any
reduction in Medicaid or CHIP payments, even a cut as seemingly insignificant as one percent, will further erode the phy- sician network. Any cut also would be grossly unfair to the physicians still bear- ing the brunt of the dual-eligible cut en- acted this year.”
should include elements that reflect the diversity of physician practices and give physicians the freedom to choose a model that works for their practices and patients and encourage incremental changes with positive rewards, instead of using penalties to order abrupt changes in care delivery.
Medicine wants better Medicare system
The Texas Medical Association joined the American Medical Association and more than 100 state and specialty medi- cal societies in an October letter urging Congress to not just repeal what physi- cians contend is a flawed Medicare pay- ment formula, but to replace it with a system grounded in a set of core princi- ples doctors say are essential to success- fully transition to a “high-performing” Medicare program. At a time when innovative health
care delivery and payment models that can boost care quality while lowering costs are under way, the current Sustain- able Growth Rate (SGR) formula is an “enormous impediment” to such reforms, physicians warned. The formula does not keep up with the cost of care, and the constant threat of steep cuts and last-minute congressional action creates an environment of uncertainty for physi- cians, their senior patients, and access to care.
A looming 27-percent payment cut is set to take effect Jan. 1, 2013. Although the SGR must be eliminated, “the physician community recognizes that this is only one-half of the equation,” the letter states. Successful delivery reform that provides patient choice also is a must, along with new payment models that reflect the expense of providing ser- vices, as well as efforts to improve qual- ity and manage costs. Physicians want to ensure a “robust
transition period that can fill the gap” between elimination of the SGR for- mula and implementation of a new na- tionwide system. That transition plan
46 TEXAS MEDICINE December 2012
Any new system should be structured in a way that allows physicians to take a leading role in health care delivery, while offering a way for them to mea- sure, demonstrate, and achieve rewards for progress on quality and costs, orga- nized medicine said. Among other crite- ria, doctors also want to see that new federal policy promotes structures that:
• Reward physicians for reducing costs; • Tie incentives to physicians’ own ac- tions, not the actions of others or fac- tors beyond their influence;
• Encourage systems of care, regional collaborative efforts, and primary care and specialist cooperation while preserving patient choice;
• Allow specialty and state society ini- tiatives to be credited as delivery im- provements and recognize the central role of the profession in determining and measuring quality; and
• Provide exemptions and alternatives for physician practices for which the investments necessary to reform care delivery would constitute a hardship.
The chairs and ranking members of the Senate Finance and the House Ways and Means, and Energy and Commerce committees received the letter. n
Amy Lynn Sorrel is an associate editor of Texas Medicine. You can reach her by telephone at (800) 880-1300, ext. 1392, or (512) 370-1392; by fax at (512) 370-1629; or by email at
amy.sorrel@
texmed.org.
All articles in Texas Medicine that mention Texas Medical Association’s stance on state legislation are defined as “legislative advertising,” according to Texas Govt. Code Ann. §305.027. That law requires disclosure of the name and address of the person who contracts with the printer to publish the legislative advertising in Texas Medicine: Louis J. Goodman, PhD, Executive Vice President, TMA, 401 W. 15th St., Austin, TX 78701.
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