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Texas Medicaid is at a tipping point, Texas physicians said today. “Either it might continue on its current path pushing physicians from the program, or it could make needed changes that can improve patients’ usage of care and save taxpayers money,” said Texas Medical Association (TMA) President Austin I. King, MD.

“The state need to take steps to cut back the red tape and administrative hassles that detract from the ability to provide needed care, boost overhead costs, and ultimately increase the risk for meager Medicaid payments too low for many physicians to put up with the morass,” he was quoted saying.

Texas physicians today asked state leaders asked for big changes to be sure low-income patients receive care in the most efficient manner. “The number 1 place to provide choose to Medicaid patients is our practices — not in expensive emergency departments,” said Dr. King. “Texas has the strength to make needed changes.

“Texas Medicaid spends money. The question is: Are we spending it wisely?” asked Dr. King.

The government hired Medicaid HMOs to make sure patients had cost-effective care coordination by physicians, specialists, and subspecialists, but that is not playing out across many communities in Texas.

Many physicians find Medicaid HMOs too burdensome, too slow, and too complicated. “They only boost costs,” said Douglas W. Curran, MD, an Athens family physician and member of TMA’s Board of Trustees, who were required to keep a child inside the hospital for several days while he waited for a Medicaid HMO to approve an in-home inhaler which costs less than $100.

“Then just last week I spent three hours on the phone having a Medicaid HMO hoping to get a generic prescription approved for my elderly patient after surgery. I spoken with three differing people, instead of one of them could help — that amounted to my staff and me some time to money, and delays care for my patient,” explained Dr. Curran.

San Antonio neonatologist Michael L. Battista, MD, said he can’t find a pediatrician or subspecialist to keep up his infant patients after they leave the neonatal intensive care unit. “These babies end up inside the emergency department 2-3 weeks later with complications. Care coordination is desperately needed. It would help save millions of dollars,” said Dr. Battista.

For greater decade, physician Medicaid participation rates will be in a free fall, plummeting 33 points in 14 years. In 2000, 67 percent of Texas physicians reported accepting all new Medicaid patients; by 2012, only 34 percent did, according to TMA surveys.

Physicians don’t easily decide not to see Medicaid patients. “We want to offer prenatal want to pregnant women, medications for asthmatic children, and community services for seniors wishing to stay in their homes instead of a nursing facility” explained Luis Benavides, MD, vice chair with the Border Health Caucus and a Laredo family physician.

Not only do physicians want to look after these patients but in addition many have tried unsuccessfully to enroll to take action. “It took months to obtain a Medicaid number for brand new physicians within my practice so they could take proper care of Medicaid patients and obtain paid for it,” said Dr. Curran. “After few months of calling, I finally referred to as the Health and Human Services commissioner myself — as well as a few days later the challenge was solved. I was lucky. I had use of the top, although not everyone does. One physician group in Athens waited greater than a year to have its newly recruited physician Medicaid credentialed. That’s just wrong.”

“We discovered that it doesn’t take much to incentivize physicians to stay in the program,” said Dr. King. The Affordable Care Act increased Medicaid payments to Medicare rates for eligible primary care physicians for the past two years. According to TMA’s 2014 physician survey, the very first time since the 2007 Frew lawsuit, physicians’ participation in Medicaid increased — to 37 percent. The payment incentive is now offering expired.

“I guarantee you the numbers will drop unless Texas keeps those primary care payment rates going,” Dr. King said. “Better yet is always to extend these to all physicians and all services.”

To accomplish TMA’s goal of improving Medicaid patients’ usage of physicians care while saving tax dollars, the association is asking lawmakers to look at these six steps:

Improve physicians’ Medicaid payments;

Cut Medicaid red tape and administrative hassles;

Hold Medicaid HMOs responsible for establishing adequate physician networks of looking after for patients;

Restore funding for Medicaid-Medicare “dual-eligible” patients;

Stop unfair and unreasonable fraud and abuse audits; and

Find an imaginative solution to pull down federal dollars to be sure working poor adults have entry to health care.

These six steps are outlined in TMA’s Healthy Vision 2020 Second Edition: Caring for Patients in a Time of Change.

“The state is wanting to balance the budget on the backs of physicians, and our backs are breaking. We can’t get it anymore,” said Dr. King. “We require a plan not just for the present but additionally for patient care from the future.” - See more at: http://www.texmed.org/Template.aspx? id=32895&utm_source=Informz&utm_medium=Email&utm_campaign=Insert+mailing+name+here#stha sh.2Gkfrse1.dpuf