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Call to Action

Posted By Administration, Monday, October 13, 2014

MAOPS President Assembles Medicaid Expansion/Reform Task Force

 By Lee Parks, D.O., MAOPS President


As President of MAOPS, I believe it’s time for us to come forward with a position on Medicaid. I am asking for volunteers to serve on a new task force I am creating to address Medicaid Expansion/Reform here in Missouri. This is an issue that we can no longer ignore as a professional physician society. It is not going to go away, and if we don’t provide guidance to legislators, we are asking them to make the decision for us. I, for one, would rather have a voice, and I hope you agree.

I am looking for a diverse group of up to six physicians representing various parts of the state, different specialties, practice situations and political affiliations to fill the task force. Members of the task force must pledge to look at data with an open mind and respect for the opinions of our membership as a whole. I am asking MAOPS members to submit their thoughts in the “Comments” section of the Association Blog, along with any statistical data or other research from reputable sources relevant to this discussion. The timeline will be short, as I would like to have this ready for the next legislative session starting in January. If you are interested in serving on this important committee please submit the short application by November 1.

MAOPS also needs the input of membership to formulate a position on Medicaid reform/expansion. Legislators are asking our Legislative Liaison (Brad Bates) for this information. MAOPS needs to give our elected representatives in Jefferson City some of the guidance they are beginning to request on Medicaid reform/expansion. As a respected voice of organized medicine, we need to speak up for ourselves and our patients, giving our legislators OUR vision of the future of Medicaid. This vision needs to be fair, economical and efficient, and it needs to come from our vast experience with the limitations of the current system.

It is no longer enough to say that there are a certain number of people who cannot get access to care or that the state cannot afford to add to the roles of recipients because it is already spending too much money. The truth is that there ARE a lot of people who are having trouble getting care, there IS a problem with getting physicians to take this low-paying insurance, and meanwhile, the care received is fragmented and ineffective.

We pay for this in different ways. In the United States, the prison system is the biggest provider of mental health care, as people with various kinds of mental illnesses are not diagnosed and/or treated until their illness brings them to the attention of law enforcement. Additionally, instead of teaching people what a healthy diet looks like, we render catastrophic care for cardiovascular disease. We have worse statistics around prenatal care than Cuba and Romania! Our ERs are full of people with bad teeth, untreated mental disorders and people seeking pain relief in dysfunctional ways.

At the same time, Missouri graduates more than 500 physicians a year, with the majority coming from osteopathic programs. These physicians, from private osteopathic education programs with high debt loads, mostly leave the state to practice in their home states or where the residency of their choice may be located. Statistics show that physicians tend to find practice locations near where they did their postgraduate training. Missouri could facilitate some of the community-based training programs that put young physicians into the kind of setting where they will eventually practice primary care.

Missouri is also the home to what is arguably one of the most successful Accountable Care Organizations (ACOs) in the country – the Mosaic system of Kansas City. Mosaic has demonstrated sufficient cost savings/patient satisfaction with team-based care in a medical home model to receive a substantial financial reward in the past year from the federal government. If I understand the system correctly, each physician heads up a miniature team comprised of a nurse practitioner, a mental health counselor and a case manager. Each team member works at the top of his/her license to give patients the medical home envisioned.

Crider Center, where I work, is an FQHC growing out of an older community mental health organization. (We recently merged with Pathways, which is another organization that has provided mental health care for a large portion of rural Missouri for many years.) With the kind of care we are able to provide to our challenged patients in this model, we see substantial changes in health, ER use and general level of functioning once they realize we are here for the long haul. We are also able to address very longstanding issues of chronic pain, drug abuse and the most debilitating of the dental problems (usually with United Way money), while working on changing lifestyle problems. We work under a confusing patchwork of funding through the Department of Mental Health, Medicaid and so on, to achieve our results. And, we work in the local school systems providing mental health services (50 percent of mental illness will be diagnosable by age 14).

My point is this: There are good things happening in Missouri that could be replicated, and there are a lot of places where change needs to occur. The state government can be a player in making that happen, but our legislators are not medical people for the most part. WE are the ones in the exam rooms, ERs, nursing homes and radiology suites. WE are in a position to tell them how to spend the money more wisely and what will really make a difference to their constituents. WE are the ones who can tell decision makers why it’s hard to find a specialist to take a patient, how much it would help a chronic pain patient to get a couple weeks of physical therapy or OMT instead of a script for Vicodin or how severe the mental health crisis is over the entire state. WE also need to be leaders, because whatever the solutions that are proposed, WE, as citizens of Missouri, will be impacted financially even if we never see a Medicaid patient.

Help MAOPS develop our policy on Medicaid expansion/reform by taking a few minutes and responding to this blog with your ideas on what a successful plan would contain. You can log in and respond directly to this blog or email your comments to our Executive Director Brian Bowles, and he will ensure they are considered by the task force. This is your opportunity to have a voice regarding the future of healthcare in Missouri. Please take advantage of it!

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