May 7, 2025 • 25 mins
This episode of the MGMA Member Spotlight Podcast features Robin Fagala, Practice Manager at Conway OBGYN in Arkansas. Discussing her groundbreaking advocacy for maternal health, Fagala shares her journey of addressing critical healthcare challenges, securing increased Medicaid reimbursements, and ultimately helping to secure a $17 million federal grant to improve maternal health outcomes in Arkansas.
Episode Highlights:
Healthcare Career and Professional Background
- 01:22 Robin's 26-year healthcare journey
- 03:32 Conway OBGYN practice overview
Maternal Health Crisis in Arkansas
- 07:12 Maternal mortality rates and challenges
- 11:28 Lack of Medicaid-accepting OB/GYN providers
- 14:53 Financial impact on healthcare providers
Advocacy and Data-Driven Problem Solving
- 13:11 Using MGMA Data Dive platform
- 15:17 Developing comprehensive documentation
- 16:53 Persistent communication with state leaders
Reimbursement and Healthcare Policy
- 14:53 Detailed analysis of OB/GYN procedure code reimbursements
- 15:17 Presenting financial sustainability challenges
- 22:35 Successful negotiation for fee schedule increases
Professional Networking and Collaboration
- 19:28 Leveraging MGMA and regional healthcare networks
- 22:35 Importance of collaborative problem-solving
- 23:08 Using professional resources to drive healthcare improvements
Resources:
- Arkansas Foundation for Medical Care (AFMC)
- Connect with Rob Fagala on LinkedIn
- Conway OB-GYN
Additional Resources:
Email us at dwilliams@mgma.com if you would like to appear on an episode. If you have a question about your practice that you would like us to answer, send an email to advisor@mgma.com. Don't forget to subscribe to our network wherever you get your podcasts.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Daniel Williams (00:52):
Well, hi, everyone. I'm Daniel Williams,
senior editor at MGMA and hostof the MGMA Podcast Network. I
am back today with another MGMAmember spotlight podcast, and
we're joined today by RobinFagala of Conway OBGYN in
Conway, Arkansas. And this is areally interesting story and one
(01:14):
for other MGMA members to beaware of that there are people,
some of your peers out therelike Robin. They're doing really
interesting things, and Robin'swork was brought to my attention
and was championed by severalpeople.
So if you're ever interested inbeing in this MGMA podcast
(01:37):
spotlight, please send me yourinformation or have someone else
do that. So let's get to whatRobin's been doing. She has been
at the forefront of maternalhealth advocacy in her state,
and her efforts recently helpedsecure a $17,000,000 federal
grant to support maternal healthinitiatives. And we are so
(02:00):
excited to hear more about herstory and what this funding
means for the future of care forwomen and families in Arkansas.
Robin, welcome to the podcast.
Robin Fagala (02:11):
Thank you, Daniel. I'm really appreciative of you
taking the time to share mystory. This is not about me.
This is really about what I feltwas something that needed
attention brought to it, andadvocating on behalf of not only
my physicians and propercompensation, but also for our
(02:33):
patients. We have a situation,I've been in healthcare for
about twenty six years.
I started in dermatology, workedin OB, then went to pediatrics,
and now I'm back in OB. Beenhere for fourteen years, I love
what I do, and I'm verypassionate about helping people.
I think anybody that has comeinto health care, that had to be
(02:56):
probably a big motivatingfactor. My physicians and my
providers share that same view.They believe that good health
care should be available to allpeople.
Now I'm not saying I'm anadvocate for free health care
unless you're doing mission workor working in a pre clinic, nor
am I a fan of socializedmedicine, but they want to do
(03:19):
the right thing morally andethically, and we believe that
is making healthcare availableto all people. I grew up with
three younger sisters, so Ilearned how to fight at an early
age. I think anybody withsiblings understands that. But
because of that, I've also hadto learn how to come to
(03:40):
resolution with problems. Therehas to be a respectful way to
come to to present a problem,and the saying you get more
flies with honey than withvinegar, that's really true.
You need to be respectful ofpeople when you're bringing a
situation to them.
Daniel Williams (03:59):
Yeah. Let me just jump. I wanted to ask you
real quick. Tell us a little bitabout Conway OBGYN. It's in
Conway, Arkansas.
You've been there, I believe,fourteen years. Tell us a little
bit about the practice and whatyour role is there, and then
let's get into this grant andthe other work you've been
doing. But just on your day today, talk about that.
Robin Fagala (04:22):
Okay. Conway OBGYN was created and formed in 1980
by doctor Paul McChristian. Sowe've been here over forty
years, and doctor McChristianwas the first OB GYN in Conway.
He had a vision for Conway. Hehe actually, his first weekend
here was the weekend that themissile silo blew up about an
(04:43):
hour north of here.
So he got thrust into thatspotlight very quickly. Conway
is a three city a three collegetown here in Central Arkansas,
just 30 miles north of LittleRock. So we've got a busy
practice. We currently have fourdoctors, one another coming to
join us in July, and we havefour nurse practitioners. We see
(05:06):
a lot of people every singleday.
Our practice is probably, Iwould say, sixtyforty percent,
60% OB, forty GYN care. OurMedicaid population is probably,
I'd say, twenty five to thirtypercent of our
patients. That does include genand OB patients. There are three
(05:32):
other clinics, actually fourother clinics here in town. It
falls to me to, of course, asmanager to monitor our
financials, our patientdemographics, our payer mix, all
of that. And as that changes,then we have to react to that
and see how that's affecting usfinancially.
(05:52):
Did I answer your question?
Daniel Williams (05:53):
I think you did. Yeah. You sure did. I
appreciate that. And then I'lljust follow-up then.
And then what do you see as yourmost important role there at
Conway?
Robin Fagala (06:06):
When we that's like when people ask you, what
did you do to at work today?What'd you do off the man, I was
busy all day long. I tell mydoctors that I am super
protective of my doctors. Ibelieve they are the best
doctors in this area, and I'mvery proud of our staff. Our
staff is exemplary.
(06:27):
I would put them up againstanybody's staff any day. My main
goal is to keep the practicemoving forward, to keep us
compliant, and to keep uscompetitive. I joke with my
doctors and tell them, hey, I'vegot your back. I'm taking care
of you, and I will let you knowwhen you wanna do things that
(06:48):
you just can't do becausethey're either not they don't
study up on health care law andthings like that. But if
something happens and I tellthem, you can't do this, you
have they can decide.
Are they gonna do this orthey're not gonna do this? They
have their own free will. Theysaid, and I love you, but I'm
not going to jail for you. Andthey just laugh. Of course,
(07:10):
we're not doing anythingillegal, but protecting the
clinic and keeping us viable,and we want to be known as the
place where everybody wants togo.
Everybody wants to work there,and we want to be the clinic
that all patients want to go to.And keeping that vision at the
forefront, treating people likeyou would treat your own mother,
(07:33):
your sister, your aunt, yourcousin, that's important to me
because these patients areimportant, Not because they're
patients, but just because theyare who they are. People are
important.
Daniel Williams (07:47):
Yeah. Thank you for sharing that. Now let's talk
about the recent $17,000,000grant from the Centers for
Medicare and Medicaid Services.What was your involvement in
that effort, and how did it allcome together?
Robin Fagala (08:01):
I cannot take any credit for that $17,000,000
grant. I would love to be ableto tell you I did. But a little
background, in 2020, thematernal mortality rate in
Arkansas was thirty five pointeight deaths per 100,000 live
births. And while the rest ofthe nation averaged twenty three
(08:22):
point eight maternal deaths per100,000 live births. And
unfortunately, Arkansas wasknown as the leader in maternal
mortality, and that's notsomething you wanna be known as
the leader for.
Every person is important tosomebody, and so we need to do
(08:43):
what we can to decrease thatnumber. Our governor, Sarah
Huckabee Sanders, set up acommittee to review this
situation, and they worked tocome up with interventions and
solutions to prevent thesedeaths. The committee consisted
of physicians, maternal fetalmedicine physicians, OBGYNs,
(09:03):
pediatricians, family practicedoctors, other medical
professionals, nursing staff.Our surgeon general is doctor
Kay Chandler, and she is an OBGYN physician, and she is a
delight. She is very passionateabout her practice and her
consistent care for women.
(09:24):
Then we had representatives fromArkansas Foundation for Medical
Care. I don't know if otherstates have groups like AFMC,
but this is a group of peoplethat help facilitate things for
us as providers, provideeducational opportunities, and I
worked with Cheryl Hurt on this.And when I first started
(09:49):
realizing part of this maternalfetal problem was because we
didn't have enough physiciansand providers that were willing
to take these patients. A bigpart of that is because in
Arkansas, the OBGYN codes, and Icreated the table of these
(10:14):
delivery codes and periperinatal codes, and just went
out and made a table of this isthe code, this is how much it
costs, and this is what Medicaidreimburses. We had not had an
increase in the fees and thereimbursement for those codes
since 02/2002 or 02/2003.
(10:36):
'20 '3 years, we had not had anincrease. Nobody works for what
they made in 2023. You can'tsurvive on that. My doctors kept
providing care because theybelieved it was the right thing
to do, and the whole time, I'msaying we've got to look at
(10:57):
this. Yes, we need to providecare, but something's gotta
give.
That is a huge reason thatpeople weren't seeing Medicaid
patients. At one point, we're inCentral Arkansas, and there was
not another OB GYN provider thatwould accept Medicaid patients
between Conway and Memphis. Wow.That is a lot of territory. We
(11:21):
have OB patient that would comefrom South Arkansas,
Southeastern Arkansas, and cometo see us because they couldn't
find a Medicaid provider.
So I started formulating a planand shaking some stuff to see
what's gonna fall out, and Icontacted Cheryl at AFMC and I
(11:43):
said, hey, This gotta change. Wecan't do this. And she said, see
what you can do. Over a periodof four years, I talked to
everybody and anybody that wouldlisten. I was like that little
kid that kept grabbing your coatand pulling on it and saying,
hey.
And I was always kind, but therewere times that I was more firm,
(12:04):
and it just seemed to be atcertain people weren't
listening. And I think it wasmore that the legislatures and
the people that set our fees andlook at these didn't realize
that there was such a bigproblem. I sent a letter to our
(12:24):
governor and to our legislatorsand explained what was going on,
that there was a big pushregarding maternal mortality. I
felt a big reason was becausethere was not physician care
provided, and the reason forthat is because we hadn't had a
raise in twenty three years.They actually listened to what I
(12:46):
had to say, but I did myresearch.
I contacted SVMIC is our medicalmalpractice carrier, And they
are fabulous.
I love our people. I love myrep, Melanie Hilton, Sharon
Theriault. They've beenwonderful to help me with things
through the years. And so Icontacted Michael Cash, and
(13:07):
Michael has been a big help aswell.
He asked him to pull some datafrom MGMA's data dive. They have
the access to the full database.And so he pulled data from what
parents say? Basically, what thefull time employee cost is for
(13:30):
our full time employees. We tookthe mean.
We didn't go to the highestlevel. We took the mean average.
He pulled the RVUs for me forthe cost, and I was able to take
that information, calculate out,and Medicaid Arkansas Medicaid
was paying us 1,212 hundred and$80, I believe, for a vaginal
(13:53):
routine delivery. Nine months ofcare. And our cost, just for our
cost, not just a made up number,but with the data, we were
losing $951.95 for everyMedicaid OB that we accepted.
(14:13):
That was everything you have toconsider, staff costs,
utilities, supplies, everything.And so in my letter, I
referenced that. I included thedata tables, and I told them the
Medicare rate, I think, was like2,100 and something dollars, and
(14:35):
this, the 59,400 code, cost usabout $2,161.95 Medicare
reimburses $2,018.97 for thatprocedure code. And when we're
taking that kind of loss forevery single one of those
(14:57):
patients, we can't buy betterequipment, we can't hire more
staff, which our staff does anamazing job, but they deserve
raises, they deserve to havebonuses. We need to be able to
buy supplies, and my doctorswere the ones that were eating
that cost.
And I don't believe that weshould be required to pay, even
(15:24):
though we're not sending outcash money, to pay for that type
of outlay. I told them werespectfully asked them as our
legislators to find a way toadequately and fairly compensate
us, OB GYN procedure codes, andI attached my table, and I
didn't even attempt to look atthe gynecologic side of things.
(15:46):
I was just focusing on OB. And Iexplained, we're not trying to
issue an ultimatum, but wephysically for our business, we
cannot continue to sustain thiskind of loss, and we are going
to have to stop taking theseMedicaid patients, which is not
what we wanna do. We want toprovide the care, but we've got
(16:09):
to be paid.
And I told him I was availableto talk, and Kay Chandler, our
surgeon general, called me andshe said, hey. I've got your
letter. I'm taking it straightto the governor. Governor
Sanders was very gracious andtook the time to go through that
and look at it. I don't knowexactly the process they went
through, but we have receiveddoctor well, governor Sanders
(16:33):
made a video or presented andsaid, we're gonna be getting a
70% increase in our feeschedule.
And I thought, woo hoo. I wasdoing the happy dance in my
chair. It just proves you canmake a difference. Take the
education that you've beengiven, the educational
(16:57):
opportunities that MGMA givesyou, use the data dive platform.
Pull that data and use that tobenefit to your benefit and to
prove.
When you're an MGMA member,especially if you're certified
or if you're a fellow, you knowwhat you're talking about.
You've done your research.You've put the time in. I think
(17:18):
a lot of times, maybe we don'tget the recognition or the
credit that we deserve for that,but I'm super proud to be a
member of MGMA. I'm so thankfulfor the educational
opportunities that they broughtto me.
My doctors support me in that,and I have my certification. I
don't know if I'm gonna be braveenough to jump out there and get
(17:39):
my fellowship, but I amconsidering it.
Daniel Williams (17:42):
That's a wonderful story. Now I wanna go
back to a couple of items herebefore we sign off today. You
were advocating for theseimprovements for several years.
Oh, yes. It can be it's notinstant gratification as we
often are people are looking forin today's world.
So how did you persevere? Whatdid you do to just stand strong
(18:06):
with your convictions here tocontinue to push the buttons, to
connect with people, to make adifference? What was that like
during those long stretcheswhere you're just not seeing any
traction there?
Robin Fagala (18:18):
It can be very frustrating. And, yeah, there
was a lot of times that you Ijust felt like this is not
making a difference. It's notI'm not getting anywhere. But
then I would think again aboutmy clinic. I would think about
these patients, and bottom line,Medicaid providers were dropping
like flies because of this.
(18:41):
And it seemed like nobody couldunderstand why people were not
participating. And so everymeeting I went to, it didn't
matter if it was a region a CAMAregional physician health
organization meeting. We have awonderful PHO, executive
director, Bobby Riggs, who is anMGMA member. It didn't matter if
(19:03):
it was our state, MGMA, whichwas a great place. I pulled a
lot of support from there, and Iwould just say, hey, this is
what I'm looking at.
Do you know anybody? Who could Italk to? Do you have the ear of
somebody that I could possiblysneak in, even the side door or
(19:26):
the back door, just to make themaware? I don't think that the
state was trying to penalizeanybody. I just don't think they
were aware of the problems.
Now I did get a thing yesterdayor the day before from the state
Medicaid stating that they'recreating a panel of medical
professionals, administrators tolook at Medicaid policy and some
(19:50):
changes, and they're asking forvolunteers. And so you can fill
out an application and submit itand see if they feel like you
would be a good fit. So I'mprobably gonna do that. I have
to run that by my doctors.That's a way reach out to your
friends, connect.
The MGMA network, go to yourmeetings, connect with people
(20:13):
because that provides you a lotof support.
Daniel Williams (20:17):
Okay. Last question then. You did go
through a process. You alludedto it earlier, but you put
together a letter eventuallythat helped push this over the
line. But how did you know whereto start?
Where did that kind of kernelthat you had the passion that
this isn't working? You'd lookedat Datatype. You'd looked at
(20:38):
other analytics. You'd looked aty'all's numbers, saw that you
were losing money on each one ofthose patients there. So where
did this all come together whereyou took it from we have a
challenge and a problem?
Now I need to get out there andbe an advocate to make a
difference here. Where'd youtalk about that part of it.
Robin Fagala (21:00):
I had no idea where to start. I really didn't,
and I think that's where mostpeople, when they they find a
problem and they're not surewhere to take it to the next
level. Again, I reached out toeverybody I knew. When I went to
the state Medicaid meeting,those meetings aren't just to
sit and go get a boxed lunch.That's where you go to ask the
(21:21):
questions and make known issues.
Again, I was talking about AFMC,Cheryl Hurt. Cheryl, what is the
she advocates between AFMC andthe legislators, and she took my
table and my information abouttwo years ago and presented it
because the DHS deputy directorpresents at that state Medicaid
(21:45):
meeting every year. And he wasthe interim director at that
time, had no idea. He wasappalled. Twenty two, twenty
three years, how could you notaddress this?
So they did come up with theidea of doing a rotation every
four years. They're rotating,reviewing the fee schedules for
(22:06):
a group of providers. It mightbe neurology and dermatology and
peds one year, next year it'd bea different group. Like I said,
I reached out to everybody, andI told my doctors, listen, this
is my last ditch effort. And Ireally didn't wanna do this
(22:26):
because I didn't feel like itwas giving the legislature and
everybody the opportunity torespond, but I was considering
taking it to the media.
You know, contacting our statenewspaper and say, hey, we have
a problem. Before you dosomething like that, you need to
see if you've exhausted everyopportunity to make your
(22:50):
presentation to the powers thatbe. Find your state legislators.
Make sure that that you can talkto somebody in the legislature
and say, hey. We got a problem.
So that's where I went. But yourMGMA State Association, there's
a lot of people out there, and alot of these people have the
(23:12):
same problem you do, and theyhave connections too. Exhaust
those possibilities. Use thatnetwork, and that is one thing
MGMA excels at.
Daniel Williams (23:23):
Alright. Robin Fagala, thank you for joining us
on the podcast today.
Robin Fagala (23:28):
I really appreciate the opportunity to
share. You asked me at firstwhat I'm passionate about. My
real passion is my grandbabies.Grandbabies and family, but I
thoroughly enjoyed being able toshare. I'll be glad to send you,
like I said, what I've got.
If some if it can help somebody,that would be fabulous. We don't
have to reinvent the wheel.Let's just build on what others
(23:50):
have built before and help eachother get through. That's what
we're here to help to do is tohelp each other.
Daniel Williams (23:57):
Yeah. Well, we've been joined today everyone
by Robin Fagala with ConwayOBGYN. We just wanna thank her
for the work she's been doing toelevate maternal health in
Arkansas. Her work is a powerfulexample of how advocacy and
persistence can make a lastingimpact, And I just wanna tune
(24:19):
everybody into that, listen toRobin's message, and reach out
to that MGMA network where youcan make a difference as well.
So thank you all for being MGMApodcast listeners.
Well, hi, everyone. I'm Daniel Williams,
senior editor at MGMA and hostof the MGMA Podcast Network. I
am back today with another MGMAmember spotlight podcast, and
we're joined today by RobinFagala of Conway OBGYN in
Conway, Arkansas. And this is areally interesting story and one
(01:14):
for other MGMA members to beaware of that there are people,
some of your peers out therelike Robin. They're doing really
interesting things, and Robin'swork was brought to my attention
and was championed by severalpeople.
So if you're ever interested inbeing in this MGMA podcast
(01:37):
spotlight, please send me yourinformation or have someone else
do that. So let's get to whatRobin's been doing. She has been
at the forefront of maternalhealth advocacy in her state,
and her efforts recently helpedsecure a $17,000,000 federal
grant to support maternal healthinitiatives. And we are so
(02:00):
excited to hear more about herstory and what this funding
means for the future of care forwomen and families in Arkansas.
Robin, welcome to the podcast.
Robin Fagala (02:11):
Thank you, Daniel. I'm really appreciative of you
taking the time to share mystory. This is not about me.
This is really about what I feltwas something that needed
attention brought to it, andadvocating on behalf of not only
my physicians and propercompensation, but also for our
(02:33):
patients. We have a situation,I've been in healthcare for
about twenty six years.
I started in dermatology, workedin OB, then went to pediatrics,
and now I'm back in OB. Beenhere for fourteen years, I love
what I do, and I'm verypassionate about helping people.
I think anybody that has comeinto health care, that had to be
(02:56):
probably a big motivatingfactor. My physicians and my
providers share that same view.They believe that good health
care should be available to allpeople.
Now I'm not saying I'm anadvocate for free health care
unless you're doing mission workor working in a pre clinic, nor
am I a fan of socializedmedicine, but they want to do
(03:19):
the right thing morally andethically, and we believe that
is making healthcare availableto all people. I grew up with
three younger sisters, so Ilearned how to fight at an early
age. I think anybody withsiblings understands that. But
because of that, I've also hadto learn how to come to
(03:40):
resolution with problems. Therehas to be a respectful way to
come to to present a problem,and the saying you get more
flies with honey than withvinegar, that's really true.
You need to be respectful ofpeople when you're bringing a
situation to them.
Daniel Williams (03:59):
Yeah. Let me just jump. I wanted to ask you
real quick. Tell us a little bitabout Conway OBGYN. It's in
Conway, Arkansas.
You've been there, I believe,fourteen years. Tell us a little
bit about the practice and whatyour role is there, and then
let's get into this grant andthe other work you've been
doing. But just on your day today, talk about that.
Robin Fagala (04:22):
Okay. Conway OBGYN was created and formed in 1980
by doctor Paul McChristian. Sowe've been here over forty
years, and doctor McChristianwas the first OB GYN in Conway.
He had a vision for Conway. Hehe actually, his first weekend
here was the weekend that themissile silo blew up about an
(04:43):
hour north of here.
So he got thrust into thatspotlight very quickly. Conway
is a three city a three collegetown here in Central Arkansas,
just 30 miles north of LittleRock. So we've got a busy
practice. We currently have fourdoctors, one another coming to
join us in July, and we havefour nurse practitioners. We see
(05:06):
a lot of people every singleday.
Our practice is probably, Iwould say, sixtyforty percent,
60% OB, forty GYN care. OurMedicaid population is probably,
I'd say, twenty five to thirtypercent of our
patients. That does include genand OB patients. There are three
(05:32):
other clinics, actually fourother clinics here in town. It
falls to me to, of course, asmanager to monitor our
financials, our patientdemographics, our payer mix, all
of that. And as that changes,then we have to react to that
and see how that's affecting usfinancially.
(05:52):
Did I answer your question?
Daniel Williams (05:53):
I think you did. Yeah. You sure did. I
appreciate that. And then I'lljust follow-up then.
And then what do you see as yourmost important role there at
Conway?
Robin Fagala (06:06):
When we that's like when people ask you, what
did you do to at work today?What'd you do off the man, I was
busy all day long. I tell mydoctors that I am super
protective of my doctors. Ibelieve they are the best
doctors in this area, and I'mvery proud of our staff. Our
staff is exemplary.
(06:27):
I would put them up againstanybody's staff any day. My main
goal is to keep the practicemoving forward, to keep us
compliant, and to keep uscompetitive. I joke with my
doctors and tell them, hey, I'vegot your back. I'm taking care
of you, and I will let you knowwhen you wanna do things that
(06:48):
you just can't do becausethey're either not they don't
study up on health care law andthings like that. But if
something happens and I tellthem, you can't do this, you
have they can decide.
Are they gonna do this orthey're not gonna do this? They
have their own free will. Theysaid, and I love you, but I'm
not going to jail for you. Andthey just laugh. Of course,
(07:10):
we're not doing anythingillegal, but protecting the
clinic and keeping us viable,and we want to be known as the
place where everybody wants togo.
Everybody wants to work there,and we want to be the clinic
that all patients want to go to.And keeping that vision at the
forefront, treating people likeyou would treat your own mother,
(07:33):
your sister, your aunt, yourcousin, that's important to me
because these patients areimportant, Not because they're
patients, but just because theyare who they are. People are
important.
Daniel Williams (07:47):
Yeah. Thank you for sharing that. Now let's talk
about the recent $17,000,000grant from the Centers for
Medicare and Medicaid Services.What was your involvement in
that effort, and how did it allcome together?
Robin Fagala (08:01):
I cannot take any credit for that $17,000,000
grant. I would love to be ableto tell you I did. But a little
background, in 2020, thematernal mortality rate in
Arkansas was thirty five pointeight deaths per 100,000 live
births. And while the rest ofthe nation averaged twenty three
(08:22):
point eight maternal deaths per100,000 live births. And
unfortunately, Arkansas wasknown as the leader in maternal
mortality, and that's notsomething you wanna be known as
the leader for.
Every person is important tosomebody, and so we need to do
(08:43):
what we can to decrease thatnumber. Our governor, Sarah
Huckabee Sanders, set up acommittee to review this
situation, and they worked tocome up with interventions and
solutions to prevent thesedeaths. The committee consisted
of physicians, maternal fetalmedicine physicians, OBGYNs,
(09:03):
pediatricians, family practicedoctors, other medical
professionals, nursing staff.Our surgeon general is doctor
Kay Chandler, and she is an OBGYN physician, and she is a
delight. She is very passionateabout her practice and her
consistent care for women.
(09:24):
Then we had representatives fromArkansas Foundation for Medical
Care. I don't know if otherstates have groups like AFMC,
but this is a group of peoplethat help facilitate things for
us as providers, provideeducational opportunities, and I
worked with Cheryl Hurt on this.And when I first started
(09:49):
realizing part of this maternalfetal problem was because we
didn't have enough physiciansand providers that were willing
to take these patients. A bigpart of that is because in
Arkansas, the OBGYN codes, and Icreated the table of these
(10:14):
delivery codes and periperinatal codes, and just went
out and made a table of this isthe code, this is how much it
costs, and this is what Medicaidreimburses. We had not had an
increase in the fees and thereimbursement for those codes
since 02/2002 or 02/2003.
(10:36):
'20 '3 years, we had not had anincrease. Nobody works for what
they made in 2023. You can'tsurvive on that. My doctors kept
providing care because theybelieved it was the right thing
to do, and the whole time, I'msaying we've got to look at
(10:57):
this. Yes, we need to providecare, but something's gotta
give.
That is a huge reason thatpeople weren't seeing Medicaid
patients. At one point, we're inCentral Arkansas, and there was
not another OB GYN provider thatwould accept Medicaid patients
between Conway and Memphis. Wow.That is a lot of territory. We
(11:21):
have OB patient that would comefrom South Arkansas,
Southeastern Arkansas, and cometo see us because they couldn't
find a Medicaid provider.
So I started formulating a planand shaking some stuff to see
what's gonna fall out, and Icontacted Cheryl at AFMC and I
(11:43):
said, hey, This gotta change. Wecan't do this. And she said, see
what you can do. Over a periodof four years, I talked to
everybody and anybody that wouldlisten. I was like that little
kid that kept grabbing your coatand pulling on it and saying,
hey.
And I was always kind, but therewere times that I was more firm,
(12:04):
and it just seemed to be atcertain people weren't
listening. And I think it wasmore that the legislatures and
the people that set our fees andlook at these didn't realize
that there was such a bigproblem. I sent a letter to our
(12:24):
governor and to our legislatorsand explained what was going on,
that there was a big pushregarding maternal mortality. I
felt a big reason was becausethere was not physician care
provided, and the reason forthat is because we hadn't had a
raise in twenty three years.They actually listened to what I
(12:46):
had to say, but I did myresearch.
I contacted SVMIC is our medicalmalpractice carrier, And they
are fabulous.
I love our people. I love myrep, Melanie Hilton, Sharon
Theriault. They've beenwonderful to help me with things
through the years. And so Icontacted Michael Cash, and
(13:07):
Michael has been a big help aswell.
He asked him to pull some datafrom MGMA's data dive. They have
the access to the full database.And so he pulled data from what
parents say? Basically, what thefull time employee cost is for
(13:30):
our full time employees. We tookthe mean.
We didn't go to the highestlevel. We took the mean average.
He pulled the RVUs for me forthe cost, and I was able to take
that information, calculate out,and Medicaid Arkansas Medicaid
was paying us 1,212 hundred and$80, I believe, for a vaginal
(13:53):
routine delivery. Nine months ofcare. And our cost, just for our
cost, not just a made up number,but with the data, we were
losing $951.95 for everyMedicaid OB that we accepted.
(14:13):
That was everything you have toconsider, staff costs,
utilities, supplies, everything.And so in my letter, I
referenced that. I included thedata tables, and I told them the
Medicare rate, I think, was like2,100 and something dollars, and
(14:35):
this, the 59,400 code, cost usabout $2,161.95 Medicare
reimburses $2,018.97 for thatprocedure code. And when we're
taking that kind of loss forevery single one of those
(14:57):
patients, we can't buy betterequipment, we can't hire more
staff, which our staff does anamazing job, but they deserve
raises, they deserve to havebonuses. We need to be able to
buy supplies, and my doctorswere the ones that were eating
that cost.
And I don't believe that weshould be required to pay, even
(15:24):
though we're not sending outcash money, to pay for that type
of outlay. I told them werespectfully asked them as our
legislators to find a way toadequately and fairly compensate
us, OB GYN procedure codes, andI attached my table, and I
didn't even attempt to look atthe gynecologic side of things.
(15:46):
I was just focusing on OB. And Iexplained, we're not trying to
issue an ultimatum, but wephysically for our business, we
cannot continue to sustain thiskind of loss, and we are going
to have to stop taking theseMedicaid patients, which is not
what we wanna do. We want toprovide the care, but we've got
(16:09):
to be paid.
And I told him I was availableto talk, and Kay Chandler, our
surgeon general, called me andshe said, hey. I've got your
letter. I'm taking it straightto the governor. Governor
Sanders was very gracious andtook the time to go through that
and look at it. I don't knowexactly the process they went
through, but we have receiveddoctor well, governor Sanders
(16:33):
made a video or presented andsaid, we're gonna be getting a
70% increase in our feeschedule.
And I thought, woo hoo. I wasdoing the happy dance in my
chair. It just proves you canmake a difference. Take the
education that you've beengiven, the educational
(16:57):
opportunities that MGMA givesyou, use the data dive platform.
Pull that data and use that tobenefit to your benefit and to
prove.
When you're an MGMA member,especially if you're certified
or if you're a fellow, you knowwhat you're talking about.
You've done your research.You've put the time in. I think
(17:18):
a lot of times, maybe we don'tget the recognition or the
credit that we deserve for that,but I'm super proud to be a
member of MGMA. I'm so thankfulfor the educational
opportunities that they broughtto me.
My doctors support me in that,and I have my certification. I
don't know if I'm gonna be braveenough to jump out there and get
(17:39):
my fellowship, but I amconsidering it.
Daniel Williams (17:42):
That's a wonderful story. Now I wanna go
back to a couple of items herebefore we sign off today. You
were advocating for theseimprovements for several years.
Oh, yes. It can be it's notinstant gratification as we
often are people are looking forin today's world.
So how did you persevere? Whatdid you do to just stand strong
(18:06):
with your convictions here tocontinue to push the buttons, to
connect with people, to make adifference? What was that like
during those long stretcheswhere you're just not seeing any
traction there?
Robin Fagala (18:18):
It can be very frustrating. And, yeah, there
was a lot of times that you Ijust felt like this is not
making a difference. It's notI'm not getting anywhere. But
then I would think again aboutmy clinic. I would think about
these patients, and bottom line,Medicaid providers were dropping
like flies because of this.
(18:41):
And it seemed like nobody couldunderstand why people were not
participating. And so everymeeting I went to, it didn't
matter if it was a region a CAMAregional physician health
organization meeting. We have awonderful PHO, executive
director, Bobby Riggs, who is anMGMA member. It didn't matter if
(19:03):
it was our state, MGMA, whichwas a great place. I pulled a
lot of support from there, and Iwould just say, hey, this is
what I'm looking at.
Do you know anybody? Who could Italk to? Do you have the ear of
somebody that I could possiblysneak in, even the side door or
(19:26):
the back door, just to make themaware? I don't think that the
state was trying to penalizeanybody. I just don't think they
were aware of the problems.
Now I did get a thing yesterdayor the day before from the state
Medicaid stating that they'recreating a panel of medical
professionals, administrators tolook at Medicaid policy and some
(19:50):
changes, and they're asking forvolunteers. And so you can fill
out an application and submit itand see if they feel like you
would be a good fit. So I'mprobably gonna do that. I have
to run that by my doctors.That's a way reach out to your
friends, connect.
The MGMA network, go to yourmeetings, connect with people
(20:13):
because that provides you a lotof support.
Daniel Williams (20:17):
Okay. Last question then. You did go
through a process. You alludedto it earlier, but you put
together a letter eventuallythat helped push this over the
line. But how did you know whereto start?
Where did that kind of kernelthat you had the passion that
this isn't working? You'd lookedat Datatype. You'd looked at
(20:38):
other analytics. You'd looked aty'all's numbers, saw that you
were losing money on each one ofthose patients there. So where
did this all come together whereyou took it from we have a
challenge and a problem?
Now I need to get out there andbe an advocate to make a
difference here. Where'd youtalk about that part of it.
Robin Fagala (21:00):
I had no idea where to start. I really didn't,
and I think that's where mostpeople, when they they find a
problem and they're not surewhere to take it to the next
level. Again, I reached out toeverybody I knew. When I went to
the state Medicaid meeting,those meetings aren't just to
sit and go get a boxed lunch.That's where you go to ask the
(21:21):
questions and make known issues.
Again, I was talking about AFMC,Cheryl Hurt. Cheryl, what is the
she advocates between AFMC andthe legislators, and she took my
table and my information abouttwo years ago and presented it
because the DHS deputy directorpresents at that state Medicaid
(21:45):
meeting every year. And he wasthe interim director at that
time, had no idea. He wasappalled. Twenty two, twenty
three years, how could you notaddress this?
So they did come up with theidea of doing a rotation every
four years. They're rotating,reviewing the fee schedules for
(22:06):
a group of providers. It mightbe neurology and dermatology and
peds one year, next year it'd bea different group. Like I said,
I reached out to everybody, andI told my doctors, listen, this
is my last ditch effort. And Ireally didn't wanna do this
(22:26):
because I didn't feel like itwas giving the legislature and
everybody the opportunity torespond, but I was considering
taking it to the media.
You know, contacting our statenewspaper and say, hey, we have
a problem. Before you dosomething like that, you need to
see if you've exhausted everyopportunity to make your
(22:50):
presentation to the powers thatbe. Find your state legislators.
Make sure that that you can talkto somebody in the legislature
and say, hey. We got a problem.
So that's where I went. But yourMGMA State Association, there's
a lot of people out there, and alot of these people have the
(23:12):
same problem you do, and theyhave connections too. Exhaust
those possibilities. Use thatnetwork, and that is one thing
MGMA excels at.
Daniel Williams (23:23):
Alright. Robin Fagala, thank you for joining us
on the podcast today.
Robin Fagala (23:28):
I really appreciate the opportunity to
share. You asked me at firstwhat I'm passionate about. My
real passion is my grandbabies.Grandbabies and family, but I
thoroughly enjoyed being able toshare. I'll be glad to send you,
like I said, what I've got.
If some if it can help somebody,that would be fabulous. We don't
have to reinvent the wheel.Let's just build on what others
(23:50):
have built before and help eachother get through. That's what
we're here to help to do is tohelp each other.
Daniel Williams (23:57):
Yeah. Well, we've been joined today everyone
by Robin Fagala with ConwayOBGYN. We just wanna thank her
for the work she's been doing toelevate maternal health in
Arkansas. Her work is a powerfulexample of how advocacy and
persistence can make a lastingimpact, And I just wanna tune
(24:19):
everybody into that, listen toRobin's message, and reach out
to that MGMA network where youcan make a difference as well.
So thank you all for being MGMApodcast listeners.
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