They’re the kind of doctors you don’t really think much about until you need them – neurologists, ophthalmologists and rheumatologists, just to name a few. All are specialists and subspecialists who have extensive knowledge and experience in specific fields of medicine. HHSC is taking steps to bring more of that knowledge and expertise to children with Medicaid.
In the last two years, HHSC has initiated five different programs designed to improve access between medical specialists and the frontline primary care doctors who see children with Medicaid. All five programs are now in place in various sections of the state, and most use technology to share medical guidance and expertise far beyond where the subspecialist is located.
“The problem is that, even in urban areas where there are a lot of doctors, there is still a shortage of pediatric subspecialists,” according to Michelle Long, who coordinates implementation of the new access programs for HHSC. “The goal of these projects is to get the most we can from those specialists – either by enhancing communication and coordination between primary care providers and specialists or by making it easier for children to get the access to specialists they need.”
More efficient, effective consultations by phone
To help foster more timely and efficient consultations between specialists and primary care providers, Medicaid now reimburses for phone consultations regarding children who are receiving clinician-directed care coordination.
Training available for primary care staff
To make these phone consultations more accessible and effective, HHSC and DSHS have developed guidelines — in the form of training modules – where primary care providers can learn more about the referral process, when it’s appropriate to refer a child to a specialist and what tests might need to be done prior to a referral. The modules are posted on the Texas Health Steps provider training site. |
Dr. Brendle Glomb, associate medical director for HHSC, says the policy change should open the door to more phone consultations with specialists and subspecialists.
“We’re not talking just about complex cases here,” Glomb said. “If the primary care doctor needs to talk with a specialist about a patient who qualifies for such care, there’s a simple process that leads to that phone call.”
Improving access through telemedicine
Taking technology a few steps further, HHSC has contracted with two Texas medical schools to use telemedicine practices to give children in rural areas with Medicaid greater access to pediatric subspecialists. Texas Tech Health Science Center and the University of Texas Medical Branch Galveston (UTMB) are both using live interactive video and sound delivered via the Internet to connect pediatric specialists with children living in areas where the nearest pediatrician or specialist might be more than 100 miles away.
Glomb says telemedicine can bridge the gap. “Using telemedicine just makes sense, especially in the more rural areas of the state where parents may have to travel hours just to see a doctor. We’re bringing the knowledge and expertise of specialists to remote areas that couldn’t be reached before.”
The arrangement allows the child to be seen by a pediatric doctor specializing in the type of care the child needs without forcing the family to travel a long distance and miss hours or days of school and work. Currently, Texas Tech’s telemedicine network consists of 13 patient sites throughout west and northwest Texas offering 16 pediatric subspecialties and general pediatrics.
Meanwhile, UTMB’s telepsychiatry network has expanded to 11 local MHMR centers primarily in east and central Texas. Through the network, children with Medicaid can be seen by a pediatric psychiatrist – remarkable considering there are relatively few pediatric psychiatrists practicing in Texas. Since the project began last August, the networks have hosted more than 1,000 telemedicine appointments.
Texas PASS
In north and northeast Texas, HHSC has contracted with the University of Texas Southwestern to establish Texas PASS, the Texas Pediatric Access to Subspecialists project — a phone-based consultation and referral service. Texas PASS offers primary care providers access to UT Southwestern faculty subspecialists, each one an expert in pediatric cardiology, child psychiatry, endocrinology, gastroenterology, hematology/oncology, infectious disease, nephrology and neurology. The consulting faculty subspecialsts are also members of the medical staff at Children’s Medical Center Dallas.
Any time of the day or night, a Medicaid primary care provider in northeast or north central Texas can call a toll-free number, explain the situation to a program coordinator, and get a call back from the appropriate subspecialist within 30 minutes. During the phone consultation, subspecialists together with the primary care provider will develop a plan of care for the patient. This plan of care may include continued management by the primary care provider, referral to a network affiliated subspecialist for evaluation, or referral to an inpatient facility or emergency room for more urgent treatment.
The goal is to improve coordination and communication between primary care providers and subspecialists and thereby increase access to specialty care. Providers can learn more by calling 877-282-PASS (877-282-2722).
Integrated pediatric and mental health
As demand for mental health services increases among children with Medicaid, the supply of psychologists and psychiatrists remains relatively low. With that in mind, in September 2008, HHSC contracted with the University of Texas Health Sciences Center to establish six pilot sites in Texas that are now providing mental health services to children with Medicaid.
Rather than using technology, the specialists in this project train midlevel licensed behavioral health practitioners to work in primary care providers’ offices to screen, assess and identify mental health and behavioral health symptoms in the children they see. This allows the primary care provider to manage the patients or refer them for more specialized treatment when necessary. Each of the six pilot sites is working with five local primary care providers’ offices. Since the pilot started in September 2008, more than 27,000 children with Medicaid have had face-to-face visits with licensed mental health professionals in the pilot areas.
Loan repayment breeds more specialists
A consummate “win-win” arrangement also is adding to the pool of specialists seeing children with Medicaid. The first class of physicians and dentists participating in the Children’s Medicaid Loan Repayment Program are now fulfilling their service obligation by seeing and treating children with Medicaid. In exchange, the state will repay up to $140,000 in each medical professional’s student loans over a four year period. Although 522 doctors and dentists applied for the program last summer, enrollment was limited to 300. Although applications are accepted at any time, the cutoff for 2010 loan repayments is July 1, 2010, and again, 300 will be accepted with priority going to specialists and subspecialists and those physicians and dentists seeing patients in underserved areas of Texas.
For more information on the Children’s Medicaid Loan Repayment Program, visit the information page on the DSHS website or call 512-458-7518.
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