Many constituent chapters did exemplary work in outreach to members. Many dealt with and overcame challenges. You are all award winners in my mind.
Early comments of Medicaid officials made it clear what OAFP and our members were up against. In an early meeting with Medicaid officials were heard: What’s the big deal? So a PCP gets some extra money for the 3 Medicaid patients in the practice. Mortgaging my children’s future to give doctors a raise. Federal government can’t afford to do this. You association people are always complaining – you get a call for two and you think the world is coming to an end.
Outreach was virtually non-existent – took an informal poll at a board meeting and 100% learned about attestation process from OAFP and not Medicaid. Process uncertainty – to receive payment retroactive to January 1, 2013, you had to attest by the deadline. There have been 7 different deadlines. OAFP pushed for each of the deadline extensions. The Medicaid director actually announced one of the extended deadlines at our Legislative Conference. Technology issues – had to attest thru MITS (Medicaid Information Technology System). A number of attestations just disappeared. Suspect that people completing attestations for multiple physicians were timed out of the system. When hospital systems attested for their physicians they received confirmations that were not connected to the individual physician – so a children’s hospital might have attested for 200 pediatricians and received 199 email confirmations of attestation and not known which of the 200 attestations didn’t go through. MITS account had to be in the individual physician’s name rather than the practice name – so requests for new individual accounts melted down the system. If you able to get through to a live person on the 1-800 number of Medicaid, they were likely to give you incorrect information. Process issues: Asked if physician was board certified by the American Board of Medical Specialties. Our docs know about the ABFM but the ABMS question completely threw them and they thought they weren’t eligible. Asked for board-certification number – ABFM didn’t start issuing board certification numbers until 2010 so many people don’t have. System set up so you can’t continue if you leave blank. In calculating 60% primary care threshold, left out some of the vaccine codes.
Slow, difficult process to get past the “you people” are always complaining attitude.
My BP is normal again – or at least it is with a little simistaten boost.
Transcript of "Ohio AFP's 2013 SLC Presentation"
OAFP Communications and Advocacy
Efforts on Medicaid Payment Parity
Randy Wexler, MD, Advocacy Chair
Ann Spicer, EVP
Medicaid Payment Parity in Ohio
In Ohio, Medicaid PCP reimbursement is
59% of Medicare rates
Real $$ on that table
FPs lacked information on:
Medicaid outreach insufficient
Make OAFP members aware of enhanced
payment and attestation process
Advocate for workable attestation
Help OAFP members with attestation
and payment problems
Early comments of Medicaid personnel:
What’s the big deal?
Mortgaging my children’s future – feds can’t
“You people” are always complaining
Identified Gaps; Sought to Fill
OAFP Maintained Problem List
Ask OAFP members to let us know if
they attested and weren’t on approved
Gave us the ammunition to use to
convince Medicaid director of problems
Medicaid pledged to work with us on
Slow, difficult process
Touched Members in Positive Way
Generated more calls and emails than
any issue in recent memory
Touched members we have not had any
contact with before
Made some loyal friends for life
Ended every conversation with, “thank
you for being an OAFP member.”
Thank you for working so hard on this
and keeping me updated!
Thanks for your assistance,
patience, and hard work. I really
We appreciate the value of OAFP
Thanks for dogging this on my/our
Thank you for your persistence and
assistance with this!
If you are ever in NW Ohio I would be
delighted to buy you an adult beverage.
Thanks for all your help.
Have eliminated most of our problem list
Most have still not received payment
FFS Medicaid paid at enhanced rate
Managed care to receive $ in late Oct. to
Figuring out retroactive payments scheme
Delay is Harmful
Purpose of enhanced payment was to
increase numbers of PCPs seeing Medicaid
Still haven’t been paid so it is likely that
increase hasn’t happened
Will be used against us when we argue for
continuation of enhanced payment beyond
Dec. 31, 2014
Having input into the implementation of
legislation is just as important as having
input into the legislative process itself.
Advocacy journey doesn’t end when a bill
is signed into law.
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