LA JOYA, January 9 - Ask La Joya family practice physician Javier Saenz to sum up 2012 and he will tell you it was a nightmare.
“If you had told me I was going to be borrowing money from the bank to keep my office open, laying off staff, renegotiating loans and renegotiating contracts, working harder than ever before and making less money, I would have told you that you were crazy,” Saenz said.
But, thanks to cutbacks in funding pushed through by state lawmakers in 2011, that is exactly what happened. “The changes in funding for our dual eligible patients just hit us like a two-by-four. It just knocked us right off our seat,” Saenz said.
Dual eligible patients are those who are old enough to be on Medicare and poor enough to be on Medicaid. There are proportionally more of them in rural areas, the border region and the inner cities and less of them in suburbs. Saenz sees a lot of dual eligible patients.
The Texas Medical Association represents doctors like Saenz. The TMA recently explained what happened to dual eligible funding. “The 2011 Texas Legislature ordered a cut in dual-eligible payments as a budget-saving move. The way the Health and Human Services Commission implemented it covered two pieces of the complex interaction between Medicare and Medicaid payments to physicians. The change effectively: a) Stopped Medicaid from covering all of the dual-eligible patients' $140 annual Medicare deductible; and b) Prevented Medicaid from paying more than the Medicaid-allowable charge; this stopped Medicaid coverage of the Medicare copay,” the TMA stated.
In its efforts to highlight the crisis facing physicians impacted the dual eligible funding cuts, the TMA used Saenz as its poster child. It sent a camera crew down to his practice in La Joya to interview him. Click here to watch the video. Saenz explained to the Guardian how he survived the cutbacks.
“I used a lot of my personal savings. I got a line of credit and borrowed $100,000. Then, I had to go back to the bank and borrow another $100,000. I ran out of the first $100,000,” Saenz said.
“I also had to increase the deductible on our health insurance policy. Now, we are paying $6,000 a month on insurance for our employees and myself. We increased the co-pays. We increased everything. I renegotiated all my loans and was able to lower all my payments by about $5,000 to $6,000 a month. I could not afford to pay my loans. I lost some staff I did not rehire. I was going to expand. I did not expand.”
Hopefully, things are going to get better this year, Saenz said. He places his optimism in a decision by state leaders and HHSC to partially reverse a 50 percent cut in the Medicare deductible. The reversal came about following meetings state Sen. Juan “Chuy” Hinojosa, D-McAllen, set up in Austin last month with Lt. Gov. David Dewhurst, House Speaker Joe Straus, and HHSC Commissioner Kyle Janek.
“After he heard our story, the lieutenant governor said to the commissioner, how do we fix this? Commissioner Janek said he could make a rule change that did not require legislative approval. The only problem is they have not figured out how they are going to do it. They are due to have another important meeting soon. But, right now, we do not know if the money is coming in two weeks, three weeks, or six weeks. It will be made retroactive to Jan. 1 of this year, which is good. But, last year is a loss. We will not get that money back,” Saenz said.
Saenz said a special mention should be made of the role Hinojosa and McAllen businessman Alonzo Cantu played. “You have to give a lot of credit to Mr. Cantu and his influence across the state. He is very influential. He has done a lot of positive things, including getting the medical school down to the Valley.
“And you have to give a lot of credit to Senator Hinojosa. He is very close to the lieutenant governor. They are good friends. The lieutenant governor listens to Sen. Hinojosa. He was very instrumental in helping us to make our point that the Valley is very different.”
Saenz said he was pleased to get the opportunity at the meetings in Austin to explain how bad things were for doctors with a high dual eligible patient mix.
“I said, look, we cannot survive another year where we get a 50 percent cut on the deductible. If you have 1,000 dual eligible patients and you see them twice in two months and they have not met the deductible, and you are only going to get paid half… that means… you do the math, a thousand times, and you are losing at least $70 on each patient. That is $70,000 not coming in. You cannot survive that. It is too much of a hit,” Saenz said.
“Right now we are barely tolerating the 20 percent cut on our Medicare rates. Now to get hit again with the 50 percent deductible, a loss of $70,000 in the first month alone, you cannot survive. I explained that.”
Saenz also paid tribute to Gov. Perry. “We met with the Governor a couple of months ago and he was very receptive. He instructed Dr. Janek to go in and help out with at least part of it, the deductible, and try to fix the problem,” Saenz said. He said he was not aware, until he met him, that Perry’s wife is a nurse and his father in law is a doctor.
“He understands medicine. He told me that he understands that as a physician you have to feed your family first before you can help anybody else. If you cannot feed family then you cannot function as a physician. That is very true,” Saenz said.
Saenz said he could not believe lawmakers knew what they were doing when they cut the deductible and the co-pay for dual eligible patients. “They cannot have realized what they were doing. Without the fix, primary care would have been in a shambles in the inner cities and rural areas. It would have been a thing of the past. You would have lost all the small town doctors.”
Saenz noted that physicians have only won a partial victory in restoring the cuts for dual eligible patients. He said HHSC has yet to restore the co-pay element. That, Saenz understands, can only be fixed with the help of state lawmakers.
“I hope they restore the 20 percent co-pay. It is against the law for us to charge Medicare-Medicaid patients the deductible. So, it was coming out of our pocket,” Saenz said. “I am hoping, this session, that the legislature restores the co-pay funding and makes it retroactive to Jan. 1, just like the deductible. Senator Hinojosa says our chances are very good. He realizes there was no impact study done by the state. It has had an extreme impact on primary care.”
Asked how things currently stand for physicians in the Valley, Saenz said access to health care has deteriorated. “We have lost a lot of people. Three physicians left the area the same day we left for Austin. We have lost subspecialists. Access to care has changed. We were making improvements in the last ten to 15 years but the cuts have knocked us back.”