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Doctors tell Udall pay models hinder care

The existing model for reimbursing health care providers hinders the development of new ways of delivering high-quality medical services for patients, New Mexico physicians and nurses told Sen. Tom Udall, D-N.M., on Wednesday.

The senator met with health care providers by teleconference from the offices of the University of New Mexico Project ECHO, which uses web-based tools to help doctors and nurses treat patients with complex illnesses.

Udall also said after the meeting that President-elect Donald Trump’s vow to “repeal and replace” the Affordable Care Act threatens the Medicaid expansion that has added 258,000 New Mexico adults to the Medicaid rolls since 2013.

On Dec. 1, Medicaid enrolled 888,447 New Mexicans, or 43 percent of the state’s 2.09 million residents.

Udall said he plans to pay close attention to the confirmation hearing of U.S. Rep. Tom Price, R-Ga., who is Trump’s choice to lead the federal Department of Health and Human Services.

Price is a fierce critic of the ACA and a proponent of overhauling Medicaid, possibly by replacing direct federal funding for Medicaid with block grants to states.

“If you are really going to repeal and replace, how do you do it?” Udall said. “This is all very sketchy right now. That’s why these hearings are so important.”

Udall said he expects federal support for Project ECHO to continue under the new administration because it offers a cost-effective way of providing high-quality care for patients in rural areas.

Project ECHO uses videoconferencing tools that allow specialists at a “hub” medical center to train and mentor clinicians in underserved areas.

ECHO supports rural physicians, physician assistants and nurse practitioners who treat patients in 57 complex disease areas, including diabetes, arthritis, HIV/AIDS, substance abuse and mental illness.

The model is used at academic medical centers in 30 states, and in 20 nations around the world.

Congress recently approved the “ECHO Act” which calls on HHS and other federal agencies to find ways to incorporate the Project ECHO model into the nation’s health care system. The bill awaits President Barack Obama’s signature.

Udall said the key to expanding use of the ECHO model is developing a funding system that reimburses clinicians who participate in ECHO clinics.

Dr. Sanjeev Arora, director of UNM Project ECHO, said the existing fee-for-service payment model pays physicians only for in-person clinic visits.

“In the fee-for-service system, we are being paid to ring bells, and nobody cares if we are making music or noise,” Arora said. “We need to change the way we think about health care.”

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