Legislative Budget Board partially reverses physician pay cut for dual-eligibles

posted 12.18.12

After months of rallies, lobbying, and meetings, the Legislative Budget Board has directed the Texas Health and Human Services Commission to reverse part of the cut in physician payments for care provided to patients covered by both Medicare and Medicaid, or “dual-eligibles.”

In a special electronic communication from the Texas Medical Association, TMA says the tipping point came from a meeting State Sen. Juan “Chuy” Hinojosa, D-McAllen, organized at the Capitol last week with Lt. Gov. David Dewhurst and House Speaker Joe Straus, R-San Antonio. The group included TMA Board of Trustees Vice Chair Carlos Cardenas, M.D., of Edinburg, and TAFP member Javier Saenz, M.D., of La Joya. Although Gov. Rick Perry did not attend the meeting, TMA says his support helped move the change over the finish line.

The 2011 Texas Legislature ordered the cut in dual-eligible payments as a budget-saving move. The way HHSC implemented it covered two pieces of the complex interaction between Medicare and Medicaid payments to physicians. The change:

1. Stopped Medicaid from covering all of the dual-eligible patients’ $140 annual Medicare deductible; and
2. Prevented Medicaid from paying more than the Medicaid-allowable charge; this stopped Medicaid coverage of the Medicare copay.

The agreement reached would reinstate coverage of the Medicare deductible in 2013. Exact details of how HHSC will implement that change are still being worked out; TMA and TAFP will keep you informed as we learn more.

“It’s a great first step,” says TMA President Michael E. Speer, M.D. “Physicians across the state and their patients have been reeling from the impact of these cuts for almost a year. We definitely needed a reprieve. Since January, it’s been a true medical emergency. Physicians who care for Texas’ most sick and most vulnerable patients have had to borrow money to keep their doors open, lay off staff — some dropped out of the Medicaid program, and some did close their practices.”

TAFP Past President Robert Youens, M.D., of Weimar says the decrease in his practice revenue this year is approaching $50,000. “It seems like instead of seeking other sources of revenue the Legislature has chosen to shift the burden of cost to physicians by cutting our payment, further jeopardizing the care of the poor and disadvantaged in our state.”

“Depending on the number of visits a dual-eligible patient makes per year, [the partial reversal] restores anywhere from two-thirds to a half of what we previously received,” Youens says. “I hope that lawmakers will be able to restore the rest of that payment in the future.”

Speer said in the e-mail that TMA will continue to pressure lawmakers when the Legislature convenes in January to reverse the remainder of the cut. “We now urge lawmakers to eliminate the rest of this cut as soon as possible. While this cut has disproportionately impacted dual-eligible patients with disabilities and seniors, when physicians are forced to close their doors or reduce services, it affects all of our patients.”