McALLEN, December 13 - Reinstating the $140 deductible the State of Texas used to pay doctors for Medicare-Medicaid dual eligible patients will not solve the physician crisis in the Rio Grande Valley but it will help.
This was the message McAllen Nurse and Health Administrator Dee Treviño delivered to Lt. Gov. David Dewhurst in an email this week. The email seems to have had the desired effect because Dewhurst, Gov. Rick Perry, and Texas House Speaker Joe Straus have agreed to reinstate the deductible.
State Sen. Juan “Chuy” Hinojosa took a delegation of Valley physicians and hospital officials to meet state leaders on Wednesday and came away with an agreement that the deductible would be reinstated starting Jan. 1, 2013, with the amount increasing from $140 to $147. The co-pay part has not been restored and those involved in the negotiations say this will have to be addressed through legislation next session.
Among those on the trip were Dr. Javier Saenz of La Joya, Dr. Carlos Cardenas of Edinburg, Doctors Hospital at Renaissance (DHR) co-founder Alonzo Cantu, and DHR governmental affairs director Israel Rocha.
“The seniors who are on the program of Medicare and Medicaid are the real winners in this effort,” Hinojosa told the Guardian. “Many of our senior citizens are subject to infectious diseases. They can now rest a little more comfortably knowing they can see physicians in my District and all over the state.”
Dual eligible patients are those old enough to receive Medicare and poor enough to receive qualify for Medicaid. Medicare acts as the primary health insurer for such patients. However, Medicare will not pay the doctor’s bills until they exceed the patient’s $140 deductible for that year. As part of its cost-cutting measures, the State of Texas has not been paying the deductible or the co-pay insurance.
The problem is more acute along the border region because there are more Medicare-Medicaid patients. More than half of the 10,000 patients Dr. Saenz and his team of doctors see in La Joya are dual eligible patients. The loss of the deductible has hit his business hard. He had to use his life savings and take out a loan in order to keep his doors open. Click here to watch a video about Dr. Saenz that was produced by the Texas Medical Association (TMA).
In her letter to Dewhurst, Treviño made five points.
“No. 1: MDs in the Valley are saying to patients that they cannot be seen if they continue to keep Medicare/Medicaid as their insurance. The patients are being told their MDs saw them for free in 2012 and cannot do so in 2013.
“No. 2: Of the 850 physicians in Hidalgo County, only 155 are PCPs (primary care physicians) who will see adults. Only 136 would take Medicare/Medicaid in 2012. Most of them are limiting their Medicare/Medicaid in 2013 by a variety of means: appointments only, limited number of appointments available, encouraging patients to switch to Medicare Managed Care plans, etc.
“No. 3: Texas is 47th in the nation for PCPs. Hidalgo County is in even worse shape than Texas and that is without the additional 200,000 adult Winter Texans who are here from October through April. They can fill the available MD appointment slots and essentially prevent our local Medicare/Medicaid patients’ access. They all have insurance plans that will pay.
“No. 4: In the past six months there has been a steady trickle of MDs leaving Hidalgo County and replacements have not been arriving. Just last night, at the Hidalgo-Starr Counties Medical Society meeting, two more said they were leaving.”
“No. 5: The number of hospitalists in Hidalgo County is greater than the number of internal medicine MDs.”
Treviño concluded her email with these words: “We are in a crisis situation. Restoring the deductible payment for dual eligible patients will not cure the crisis but it will forestall the crash of the system for a little while, giving us some time to work out more lasting solutions.”
Valley physicians praised Sen. Hinojosa, state Rep. Richard Peña Raymond, state leaders and HHSC officials for reaching agreement on the deductibles issue.
Dr. Cardenas is current vice chairman of the TMA’s board of trustees and legislative affairs chairman of the Border Health Caucus He is also chairman of Doctors Hospital at Renaissance’s board of directors and a past chairman of the Hidalgo-Starr Counties Medical Society. Cardenas said: “So many people deserve credit for this effort including the state leadership of Gov. Rick Perry, Lt. Gov. David Dewhurst and Speaker Joe Strauss. Senator Juan Hinojosa worked tirelessly on this effort and he is a true champion.”
Dr. Luis Calo is president of Cameron-Willacy Counties Medical Society. He said the HHSC staff has been outstanding. “We are all winners today, our patients and doctors throughout Texas. We are blessed to have the leadership all across the border region and we appreciate all our elected officials who have been so diligent in this matter,” Calo said.
Dr. Victor Gonzalez is president of Hidalgo-Starr Counties Medical Society. He thanked the Texas Medical Association, its leadership and staff for its efforts to restore the deductible for dual eligible patients.
“This was indeed a team effort from the rallies we have had here in the border and in countless meetings in Austin. Chairman Raymond and Senator Hinojosa and all our elected officials were so helpful and supportive,” Gonzalez said.
“The state leadership, including state Sen. Jane Nelson, the chair of the Senate Committee on Health and Human Services, was very helpful. A special thanks also to Dr. Kyle Janek, the HHSC commissioner, for his leadership on this issue. He came in September 1 and hit the ground running.”
Gonzalez said he is pleased the deductible has been restored but said the fight by Valley doctors was not at an end. “We will keep on working to make sure the entire dual eligible program is restored and respected for the needs we have along the border.”