Some HIV providers stop taking Medicare patients

Other local doctors say they’ll follow suit if Congress goes through with  reductions in reimbursement rate

Vasquez.Jaime

Dr. Jaime Vasquez

DAVID TAFFET  |  Staff Writer

Some doctors have opted out of the Medicare system because Congress has threatened to cut reimbursement payments.

Bob Hutchison, 58, has HIV and is disabled from injuries he sustained on the job. He said his HIV is under control, but he needs care for his disability. He receives social security and recently qualified for Medicare. But he can’t find a doctor who’ll treat him.

The Trinity Health and Wellness Clinic can treat Hutchison for his HIV. But the facility isn’t equipped to deal with his other conditions unrelated to the virus.

Last year, Congress proposed cutting Medicare payments by almost 30 percent. A current proposal would cut payments by 27.4 percent.

Some doctors say they were already losing money on Medicare patients, but with the additional cuts they won’t be able to pay their staffs.

Trinity referred Hutchison to Parkland hospital to treat his injuries from a broken back.
But Hutchison lives in Rockwall, which has no public hospital and where residents aren’t eligible for free or sliding scale treatment at the Dallas facility.

Hutchison qualified for Medicare because of his disability. That program, known primarily for covering medical costs for people over 65, also covers the disabled.

And unlike patients using private insurance who can go out of network, pay higher rates and bill the provider themselves, Medicare users must use a doctor that accepts the program. An individual cannot choose to pay the doctor in full and then bill the government for reimbursement, even at the lower rate.

Not all Oak Lawn physicians will take new patients on Medicare. What was uniform at their offices this week was a long pause and sigh when asked about the program.

“We’re only taking Medicare from existing patients if they transfer over,” said Rick Porter, a spokesman for Dr. Steven Pounders’ office.
Pounders also has contracted with three Medicare HMOs. He said that as good as one of those plans that his office accepts is, Baylor Hospital doesn’t take it, presenting those patients with another problem.

Porter said an additional problem is that unless a patient with HIV on Medicare has a good Part D prescription plan, it’s hard to switch medications. And if the patient has to change drugs during the year, a plan that covered an existing regimen may not cover the new treatment.

Dr. Jaime Vasquez also continues seeing existing patients who have converted from private insurance to Medicare. New patients on Medicare are accepted on a case-by-case basis.

“We’re keeping a quota,” his office manager said.

She said Vasquez’s office simply can’t afford to take many additional patients with the minimal payment Medicare provides for services — which Congress is threatening to cut further.

According to the Texas Medical Association, almost half of Texas physicians are considering opting out of Medicare altogether.

Although the proposed cut in payments for 2012 hasn’t gone into effect yet as Congress remains deadlocked on this and other issues, the number of doctors accepting new patients on Medicare continues to decline.

Orthopedic surgeon Diane Litke still accepts new patients on Medicare, but she said many of her patients see her for an injury and not for long-term care. But she sided with doctors who have stopped accepting the coverage.

“I think Congress should take a 30 percent pay cut,” she said. “As soon as they cut it [Medicare], I’m going to drop it.”

Part of the problem is the uncertainty. Each year, Congress threatens to cut Medicare payments. Payments usually remain frozen.

This year, the cuts were part of a bill that recently passed extending the payroll tax cut. Before the bill passed, Medicare payment to doctors was stripped from the legislation, and so reimbursement rates remain up in the air.

Although some local doctor’s offices said they aren’t taking new patients on Medicare, some said they are.

At least three local practices with HIV specialties are accepting new Medicare patients: Uptown Physicians; Dr. Nick Bellos, who recently returned his business to Oak Lawn; and Dr. Patrick Daly.

This article appeared in the Dallas Voice print edition February 24, 2012.

—  Kevin Thomas

HIV meds program on state’s chopping block

Ending assistance could cost communities millions in added ER care and hospitalization, advocates say

DAVID TAFFET | Staff Writer
taffet@dallasvoice.com

Some of the more extreme budget cutters would like to eliminate the program that helps people without insurance receive life-sustaining medications, as the Texas Legislature struggles to pass a balanced budget.

“That would be called legalized murder,” said Don Maison, president and CEO of AIDS Services Dallas.

Among the more likely proposals being floated in Austin is to add only 400 to 500 people to the Texas HIV Medication Program (THMP) over the next two budget cycles, which runs four years.

Bret Camp

Local HIV healthcare providers said the proposed number is low compared to the number who will need the program.

Texas is a direct purchase state, according to Bret Camp, associate executive director of health and medical services for the Nelson-Tebedo Clinic at Resource Center Dallas. Camp explained that the state buys HIV medications and distributes them through a network of about 400 pharmacies throughout the state.

To qualify for THMP, a client must be diagnosed HIV-positive, be a Texas resident, be uninsured or under-insured for drug coverage, have income below 200 percent of the poverty level, and not receive Medicare.

Medicare recipients get their medication through the State Pharmacy Assistance Program.

In 1996, 5,100 people in Texas received their medication through THMP. Last year, the estimated number was 14,000.

Camp said he is concerned that increasing the number of eligible people over the next four years by just 400 would leave too many without the medications they need.

Camp said he expects the number of people needing assistance to increase significantly.

“The state is being responsible and promoting HIV testing,” he said. “The more testing, the more cases we’re likely to see.”

Just how much the state is spending on providing drugs for about 14,000 Texans with HIV is not known. Camp said that the state negotiates a price with the drug companies but does not publish the negotiated price.

“Nobody really knows what the price is,” Camp said.

Randall Ellis is the senior director of government relations for Legacy Community Health Services in Houston, formerly known as Montrose Clinic. He said that Texas probably pays in the range of $6,000 per year for someone in the program.

Individuals who have to purchase the drugs themselves or have insurance cover part of the price would pay closer to $24,000 or more.

Camp said that eliminating the program would save little when compared to the overall budget shortfall. But he said that the cost of caring for people who would have to make multiple emergency room visits and have extended hospital stays would be much higher than keeping them healthy in the first place.

Ellis said another problem is that the oversight committee, made up of stakeholders from around the state, sunsetted last fall. To reinstate the committee, the commissioner of Health and Human Services would simply have to repost the rules.

The committee made recommendations to the health department such as what drugs should be included in the program and what the eligibility requirements should be.

The commissioner, Ellis said, usually followed the committee’s recommendations. But the commissioner didn’t always want that input, he said.

“They want our input when it looks good to have community input,” Ellis said. “But when we ask tough questions, they’d rather not have us.”

Ellis does not expect all funding for THMP to be cut. He said that the state receives some funding through the federal AIDS Drug Assistance Program.

Camp said other states have thousands of people on waiting lists for ADAP programs.

“Florida is sorry right now,” he said. “They have dis-enrolled people.”

Florida has more than 3,000 waiting for medication. Unless those people find another way to get their medication, most will become sick, Ellis said, adding that if they are left untreated, those people will die.

Camp said that after recent hearings in the Senate Finance Committee, senators “seemed to leave with questions” that were on a level he hadn’t heard since early in the AIDS crisis.

On Tuesday, Feb. 15, the Texas HIV-AIDS Coalition is sponsoring Advocacy Day at the Capitol in Austin. A Dallas contingency will join groups from Houston, San Antonio and other cities as far as El Paso to talk to legislators about the need to fund the program.

For more information or to register for Advocacy Day, go TexasHIV.org.

—  John Wright

Baylor updates its definition of family, sort of

Earlier this year, an executive order from President Barack Obama went into effect requiring hospitals to allow same-sex partner visitation.

This week, the Baylor Health Care System sent a memo to its employees explaining its new policy. A copy of the memo was obtained by Instant Tea. While the policy doesn’t specifically address LGBT families, it allows patients to define who their families are.

It doesn’t appear as though the new policy will have any impact on the Baylor-owned Tom Landry Fitness Center, which refuses to sell family memberships to same-sex couples. But here’s what the Health Care System wrote:

Beginning in January, Baylor began asking inpatients System-wide to specify who they consider “family” to support them during their stay. The goal: to implement open access in all inpatient units, outpatient departments, critical care units and emergency departments System-wide during FY11.

Why Open Access?

·         Significant evidence-based literature supports the benefits of family presence for patients.

·         Benefits include reduced anxiety, improved outcomes, reduced lengths of stay, better discharge planning and fewer re-hospitalizations.

·         Having loved ones help manage the flow of information and learning heightens the patient’s confidence and compliance with recommendations.

The Centers for Medicare and Medicaid and The Joint Commission require that patients be afforded the right to have a support person during their stay unless it infringes on others’ rights or safety or is medically or therapeutically contraindicated.

What is the Support Person’s Role?

·       Patients have the right to define a support person and decide how he or she will be involved in care, care planning and decision-making.

·       Involvement may include participation in shift report, rounds and private consultation as long as confidential health information is shared only with the patient’s consent.

We appreciate your support at Baylor continues its journey toward a patient- and family-centered model and implements open access across the System.

—  David Taffet

John Cornyn to vote for DADT repeal?

Sen. John Cornyn

Texas Republican Sen. John Cornyn’s decision to accept an award from Log Cabin Republicans — the gay GOP group — in October was likely designed primarily to drum up votes and money in advance of the November mid-terms. And it may even have worked. But who knows, maybe we’ve also been a little too hard on our junior senator. Maybe, just maybe (but we doubt it), Cornyn is starting to warm up to the gays. And could you really blame him after Log Cabin sang “Happy Birthday” to his freakin’ wife?

Anyhow, we can’t seem to get a response from Cornyn’s spokesman, Kevin McLaughlin, about where he stands on standalone legislation to repeal “don’t ask don’t tell,” which is expected to come up for a vote in the Senate on Saturday. But we do know that Cornyn DID NOT VOTE last week when the Senate blocked a Defense Authorization bill that contained DADT repeal. McLaughlin won’t tell us why Cornyn didn’t vote or where he may have been (at the dentist?), and now we can’t help but wonder: Was he trying to avoid the issue? Does he have mixed feelings about DADT repeal? Is he even a potential yes vote on Saturday? Yeah, right.

Obviously Cornyn is aware of polls showing that nearly eight in 10 Americans support DADT repeal. And given recent polling numbers from Texas on other LGBT issues, we doubt support for repeal is much lower here, even though some might have you believe that.

A while back, McLaughlin issued a statement saying Cornyn felt there were more important priorities for the lame duck session than repealing DADT. Note that the statement didn’t say outright that Cornyn opposes repeal:

“There are a handful of time sensitive issues that must be addressed during lame duck,” the statement said. “A continuing resolution to fund the government, the medicare reimbursement rate also known as the ‘doc fix,’ and preventing every American from incurring a massive tax increase on the first of the year just to name a few. Sen. Cornyn believes these things should be the focus of the lame duck session.”

Two of the issues mentioned in Cornyn’s statement — Bush-era tax cuts and the “doc fix” — have now passed the Senate. Meanwhile, the omnibus spending bill containing government funding was abruptly pulled from the floor last night due to opposition over earmarks ($16 million worth of which were inserted by Cornyn). Now, the Senate is expected to vote today on a short-term resolution that would fund the government until Feb. 18.

In June, Cornyn said he didn’t believe the Senate should act on DADT repeal until the Pentagon study was complete. Then, after the study was released and showed strong support for DADT repeal, he issued the above statement. So, we’re just wondering, what will be his new excuse? At least his counterpart, Sen. Kay Bailey Hutchison, has the guts to take a position and state it for the record.

—  John Wright

A subsidy for millionaires disguised as tax cuts

Hardy Haberman  |  Dungeon Diary

So even as the Republicans are spouting blather about deficits, they are behind the extension of the immensely expensive subsidy for millionaires that has come to be called the Bush Tax Cuts. The Democrats have relented in opposing these because the GOP held unemployment benefits hostage until the subsidies were extended.

Meanwhile Republicans will rail about spending and deficits while creating an even bigger hole to dig out of. I sincerely expect they are planning to get the nation so deeply in debt that the only way out will be to cut all Social Security and Medicare to make ends meet. The GOP is relentless and they will do anything to get their way, and they hate both programs, even though the American people love and need them.

The GOP is a party of the rich, by the rich and for the rich and don’t believe them when they say anything different. They will talk about class warfare and how bad it is, but they have already won the class war. All of us are working and paying taxes to support the wealthy of this country, and it’s getting worse.

Meanwhile the Democrats try to reason and negotiate with the Republicans. It hasn’t worked in the past decade why should it work now?

—  admin

SHOCKER: With Pentagon study complete, Sen. Cornyn has new excuse for opposing DADT repeal

Sen. John Cornyn

With the Pentagon study on repealing “don’t ask don’t tell” to be released today, we inquired of Texas Republican Sen. John Cornyn’s office whether he believes it would now be prudent to move forward on this issue during the lame duck session of Congress. After all, Cornyn told us in June he didn’t believe Congress should act on DADT repeal until the study was complete.

Here’s the response we received moments ago from Cornyn spokesman Kevin McClaughlin:

“There are a handful of time sensitive issues that must be addressed during lame duck. A continuing resolution to fund the government, the medicare reimbursement rate also known as the ‘doc fix,’ and preventing every American from incurring a massive tax increase on the first of the year just to name a few. Sen. Cornyn believes these things should be the focus of the lame duck session.’

So there you have it. Repealing a discriminatory policy that hurts the military and is opposed by the vast majority of Americans is simply not a priority for our junior senator, who by every indication will be joining his party’s filibuster of the Defense spending bill to which the DADT amendment is attached. A better question at this point would probably be whether Cornyn will introduce toxic anti-gay amendments to the Defense bill if Democrats can overcome the filibuster — such as a measure to overturn same-sex marriage in D.C. If you’ll remember, this is what Cornyn tried to do with health care reform.

We still haven’t heard back on a similar inquiry to Sen. Kay Bailey Hutchison’s office, but don’t get your hopes up.

—  John Wright