Physician-led campaign encourages doctors to “take another look” at the program

Now that the Texas Legislature has passed a pay raise for participating physicians, is it time to open your doors for Medicaid?

By Kate McCann

Over the next few months, expect to see a lot of new attention paid to an old program. The Texas Medical Association has embarked on the Medicaid “Take Another Look” Campaign to attract Texas physicians back to the public health program and encourage already-participating physicians to accept more Medicaid patients into their practices.

With the opening of the 80th Legislative Session in January 2007, TAFP, the Texas Pediatric Society and TMA launched a multi-year strategic plan to make Medicaid rates comparable to Medicare and private insurance rates. Over the next five years, “all parts of the package—rates, simplification and accountability—will play a role,” says Helen Kent Davis, director of TMA’s Office of Governmental Affairs.

Texas physicians made significant gains during the Legislative Session in increasing reimbursement rates. Because of the settlement of the class-action lawsuit Frew v. Hawkins and additional advocacy work, lawmakers agreed to boost physician payment for adult Medicaid by an average 10 percent and pediatric Medicaid by an average 25 percent. These gains provide “an excellent down payment” toward their goals, TMA wrote in the January Texas Medicine cover story.

“At the very least, doctors will be losing less to see Medicaid patients in the future, and it probably gets them pretty close to a break-even rate for their office overhead,” San Antonio pulmonologist John R. Holcomb, M.D., told Texas Medicine.

To simplify some of the Medicaid administrative requirements, which San Angelo pediatrician Jane Rider, M.D., calls “a day-to-day struggle,” the Health and Human Services Commission will revise—and already has, in some cases—several aspects of the process, and implement new measures to make the requirements more user-friendly.

Many of these initiatives use the Web to make it easier to access information and forms. The online provider lookup, launched late last year, gives both Medicaid enrollees and physicians looking to make a referral a source for contact information on participating Medicaid physicians, whether the physicians accept new Medicaid patients and any of the physicians’ associated practice limitations.

One previous complaint of this directory had been that it was difficult to keep up-to-date. However, because of a requirement for physicians to change their passwords online every 90 to 120 days and check and revise their profiles, this information will be current. Enabling HHSC to make timely updates is one reason why HHSC has put many of the initiatives online, says Chris Traylor, HHSC associate commissioner for Medicaid and CHIP.

“In our conversations with physicians and others, it is much easier to access information online than to search for something that may have been mailed to someone at another time,” he says.

Also online is an electronic prior approval system—where physicians can use electronic signatures to obtain prior authorization for ambulance services, home health care, inpatient and outpatient hospital services and early childhood intervention services—and a simplified Medicaid preferred drug list, with a summary of preferred drugs on www.txvendordrug.com.

New versions of the Medicaid provider application, previously characterized as “long and arduous” for physicians, Rider says, will be available in both online and paper forms. Starting in February, physicians may complete a Medicaid provider application on the Texas Medicaid and Healthcare Partnership Web site, www.tmhp.com. Users may not submit the form until all information is included, which will reduce the incidence of incomplete submissions and re-submissions.

To revise the paper application, HHSC will gather providers of all types and advocate stakeholders, Traylor says, to simplify the application as much as possible. There are federal and state requirements “that we will continue to have to meet that will be burdensome, but any unnecessary requirement we intend on eliminating.”

In addition, the mammoth Medicaid manual containing lists of Texas Medicaid policies will be reviewed and rewritten by an outside entity to make it more comprehendible, with the new version released for 2009. Patients will be issued electronic Medicaid access cards to replace the Medicaid ID form and allow physicians to verify a patient’s eligibility quickly.

Since accepting his post within HHSC’s division of Medicaid and CHIP, Traylor has assessed and received more than $1.8 million in fines on Medicaid HMOs. He says this sends the message that HHSC is serious and committed to a Medicaid program that is client- and consumer-focused.

“The point of these damages is not to exact a pound of flesh and a gallon of blood from the HMOs,” Traylor says. “The objective of enforcing this accountability is to increase access to health care by Medicaid clients. We hope to achieve this by bringing our managed care organizations into compliance with payment standards that pay physicians within 30 days of billing.”

“There is a perception among physicians that the state has not held plans accountable for violations,” Davis says. “This tells doctors that the state is interested not only in getting them back into the program but holding [the HMOs’] feet to the fire for what they need to do.”

The next step for physicians—one that will be crucial to justify future increases—will be to show legislators that investing in a physician network will increase access to care, Rider says. “The Legislature gave more money for physician reimbursement—we’ll see an average 27 percent increase—but if we want to be able to ask for more in the future, we have to show that by giving more money, they got a product: by increasing reimbursement and increasing provider participation in the program, we increased care for the children.”

For TMA, this campaign fulfills a commitment to the Legislature, to get more physicians enrolled in the program and invest in the physician network. Davis echoes Rider’s comment—the key is to demonstrate to lawmakers that their

investment mattered and access to care increased, she says. “Also we recognize the calling of doctors to care for this vulnerable population, that they can make a difference in their lives.”

The medical association will rely on its members to complete the “most important piece” of the plan, to recruit their colleagues. Called physician ambassadors, TMA members will use one-to-one communication to ask their colleagues to come back into the program or take a few more Medicaid patients into their practices, particularly in large urban areas such as Austin, Dallas, Houston and San Antonio. “At the end of the day, they can read the magazine articles about it, but those professional relationships matter the most,” Davis says. “That’s the fundamental part that will make the most difference.”

TMA hopes that physicians seeing their colleagues in the program will encourage more physicians to join the Medicaid network to reverse a familiar and often-quoted statistic: that physicians willing to accept new Medicaid patients plummeted from 67 percent in 2000 to 38 percent in 2006.

“Ideally, we’d like to see that number reverse, but we understand that these changes don’t happen overnight; we’d like to see an up-tick by the end of next year,” Davis says. “We asked for the rate increases to be gradually implemented over five years and the collaborative approach is what’s important. We would like to stop the decline in physicians accepting new Medicaid patients and start to see a small but steady rising trend in physician participation.”

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