President's Page August 2004   Call to Action— Save the Medicaid PCCM Model

by Warren E. Lichliter, MD 2004 DCMS President

Again the organized voices of Dallas County physicians are urgently needed to prevent further deterioration in the county’s delivery of health care. The Texas Health and Human Services Commission has proposed changes in Medicaid coverage that would have disastrous consequences for patients, hospitals, and physicians.

Medicaid patients now can enroll in a Primary Care Case Management model that—although marginal—has provided coverage and access. Fewer than 50 percent of physicians in the state will see patients even in that system, and in Dallas, fewer than 20 percent of specialists will see Medicaid patients. With the proposed change, Medicaid patients will have a more difficult time seeing any physicians, more physicians will quit participating in Medicaid, and patients increasingly will seek service in emergency rooms. The ER already is the primary care facility for the 25 percent of Texans who are uninsured, immigrants, or out-of-county residents. The following information outlines the new problem and gives physicians the tools to voice our opposition to these changes.

On July 1, the THHSC informed the Legislature it intends to phase out the Medicaid PCCM model in and around urban counties. This decision would leave urban Medicaid patients with only one means for receiving care—an HMO. Twenty percent of Dallas-area physicians who accept Medicaid patients do not contract with these HMOs—they provide care through Texas Health Choice, the PCCM. The sickest patients have turned to the PCCM because of better care coordination and availability of specialists. In the Dallas, Harris, Bexar, Lubbock, and El Paso service areas, PCCM will be replaced by an HMO-only option—not only for pregnant women and children, but also for the elderly and patients with disabilities. All changes will be completed by Sept 1, 2005.

It is crucial that, as a physician, you let the governor, other top state officials, and your legislators know you oppose this decision. HHSC took the action despite overwhelming opposition from physicians, hospitals, and patients around the state, and statistics from its own consultant that show HMO and PCCM models provide comparable cost savings.

TMA Position
TMA unequivocally opposes HHSC’s decision. At public hearings across the state, testimony from physicians, patients, hospitals, nursing homes, and other healthcare providers overwhelmingly and consistently conveyed one message: Keep PCCM and stop the STAR+PLUS HMO expansion.
“It appears the concerns and needs of Medicaid physicians are of little interest to HHSC,” says TMA President Bohn Allen, MD. “Rather than working with physicians to improve the program, the state seems to be doing everything it can to drive them out.”

What to Do NOW
Contact Gov Rick Perry, Lt Gov David Dewhurst, House Speaker Tom Craddick, and your representative and senator, and tell them why the commission’s decision is bad for patients, bad for physicians, and bad for Medicaid’s long-term financial viability.
To send them an electronic message, go to the TMA Grass-roots Action Center at: http://capwiz.com/tma1/state/main/?state=TX

Or, call:
Governor Perry: 512-463-2000
Lt Governor Dewhurst: 512-463-0001
House Speaker Craddick: 512-463-1000

Talking Points

• At every public hearing, testimony overwhelmingly opposed repealing PCCM and expanding STAR+PLUS HMO.

• The state’s own consultant—The Lewin Group—found comparable cost savings between the HMO and PCCM models.

• Patients and pysicians overwhelmingly support PCCM. PCCM does as well or better than HMOs on patient and physician satisfaction surveys.

• Quality indicators, such as access to prenatal and well-child care, are comparable between the PCCM and HMO.

• Retaining PCCM especially is important for chronically ill patients because the model eliminates barriers to specialty services.

• Physician Medicaid participation is at an historic low. Only 46 percent of physicians accept new Medicaid patients, down from nearly 70 percent just four years ago. The drop in participation is most severe in the urban managed care counties—the same communities that will bear the brunt of repealing PCCM and expanding STAR+PLUS.

• Repealing PCCM will decimate what is left of the physician network, thus jeopardizing patient access to timely services. Further decline in physician Medicaid participation will undermine any long-term savings from an HMO. Without physicians to manage their care, patients will utilize already overburdened emergency rooms and public clinics at a cost much higher to taxpayers, physicians, and hospitals.

The Bottom Line
Given the public testimony, the financial data, and available outcomes data, how can HHSC justify this short-sighted decision?
The Medicaid physician network is tenuous, at best. An HMO-only model in urban areas will only heighten physician dissatisfaction with Medicaid, causing more physicians to stop accepting it.

This issue is important to us all, regardless of whether you see Medicaid patients in your practice. When the patient is in the ER and the ER calls you to cover, you have no choice but to see the patient. Providing a system of care will avoid this problem. Please register your protest with your legislators now.

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