Ohio AFP's 2013 SLC Presentation


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  • 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.
  • Ohio AFP's 2013 SLC Presentation

    1. 1. OAFP Communications and Advocacy Efforts on Medicaid Payment Parity Randy Wexler, MD, Advocacy Chair Ann Spicer, EVP
    2. 2. Medicaid Payment Parity in Ohio  In Ohio, Medicaid PCP reimbursement is 59% of Medicare rates  Real $$ on that table  FPs lacked information on:  enhanced payment  attestation process  Medicaid outreach insufficient
    3. 3. OAFP Goals  Make OAFP members aware of enhanced payment and attestation process  Advocate for workable attestation process  Help OAFP members with attestation and payment problems
    4. 4. Unfavorable Environment  Early comments of Medicaid personnel:  What’s the big deal?  Mortgaging my children’s future – feds can’t afford this  “You people” are always complaining
    5. 5. Identified Gaps; Sought to Fill  Outreach  Process uncertainty  Technology issues  Process issues
    6. 6. OAFP Maintained Problem List  Ask OAFP members to let us know if they attested and weren’t on approved list  Gave us the ammunition to use to convince Medicaid director of problems  Medicaid pledged to work with us on problem resolution  Slow, difficult process
    7. 7. 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.”
    8. 8. Member Response  Thank you for working so hard on this and keeping me updated!   Thanks for your assistance, patience, and hard work. I really appreciate.  We appreciate the value of OAFP membership.
    9. 9. Member Response  Thanks for dogging this on my/our behalf.  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.
    10. 10. Status  Have eliminated most of our problem list  Payment  Most have still not received payment  FFS Medicaid paid at enhanced rate  Managed care to receive $ in late Oct. to begin payments  Figuring out retroactive payments scheme
    11. 11. Delay is Harmful  Purpose of enhanced payment was to increase numbers of PCPs seeing Medicaid patients  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
    12. 12. Lessons Learned  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.