Dual eligible reimbursement ‘critical’ for local doctors


By:  Joey Gomez

The Texas Medical Association, along with the Hidalgo Starr County Medical Association held a news conference and rally in McAllen in March to talk about changes in Medicaid that have had a “profound” impact on the healthcare delivery of adults and elderly patients in the Rio Grande Valley.

Hundreds of healthcare providers crowded the parking lot of a local Medicaid office voicing their opinions about steep budget cuts they say threaten patient care. They are petitioning Texas legislators and the Legislative Budget Board to reverse the cap on Medicaid allowable payments for dual eligible patients, those who are old enough to receive both Medicare and Medicaid assistance.

Dr. Carlos Cardenas, Chairman of the Board at Doctors Hospital at Renaissance, and Board Trustee on the TMA focused on two key issues. The Valley has a very large population of patients in who are elderly, and the cuts made by lawmakers affect them the most, he said.

Secondly, local healthcare providers are in the dark without a timetable explaining when they can expect Medicare reimbursement for the first time this year, he said.

“The Legislature has the obligation to care for its people. I think this is an unintended consequence. What we need is a timetable. When is this going to happen? Is it going to be this week? Next week? We can’t wait until the next legislative session. This must happen now. The very fabric that holds this medical community is unraveling before our eyes,” Cardenas said at the press conference.

Also in attendance at the event was Dr. Bruce Malone, an orthopedic surgeon and current president of the TMA, which represents over 45,000 physicians statewide; and Dr. Luis Calo, a family practitioner from Harlingen who is the current president of the Cameron Willacy Medical Society.

In the Valley, doctors estimate that on average, physicians have a patient mix that is 60 percent dual eligible. In the aftermath of budget cuts following last year’s legislative session, physicians say they are receiving 20 percent less money for seeing these types of patients.

“The TMA is here to try and harness some of the passion that Dr. Cardenas has to you so you can help us finish the job of getting this fixed,” Dr. Malone said. “The people who are most affected are our most fragile, our elderly, our poor, and the ones unable to fend for themselves.”

Dr. Victor Gonzalez, ophthalmologist with Valley Retina Institute and the current president of the Hidalgo Starr County Medical Society called the situation “critical”.

“This situation happens to be a very critical one. As you already know, the Valley is a very unique community. The border region is a very unique community, and unfortunately we have a large number of patients who depend on a lot of the assistance programs to properly take care of their medical issues and their health, he told attendees at the rally.

“Unfortunately, because of the current budgetary issues In Austin, drastic cuts have been made to our Medicaid program. This has resulted in very unexpected consequences, and the consequences include everything from having physicians leave the area, which now stresses our medical infrastructure, to having the potential in the future for not having enough workforce to be able to take care of our patients,” Dr. Gonzalez said at the event.