Member Spotlight: Robin Fagala Wins Maternal Health Grant for Arkanas
Download MP3Well, hi, everyone. I'm Daniel Williams, senior editor at MGMA and host of the MGMA Podcast Network. I am back today with another MGMA member spotlight podcast, and we're joined today by Robin Fagala of Conway OBGYN in Conway, Arkansas. And this is a really interesting story and one for other MGMA members to be aware of that there are people, some of your peers out there like Robin. They're doing really interesting things, and Robin's work was brought to my attention and was championed by several people.
Daniel Williams:So if you're ever interested in being in this MGMA podcast spotlight, please send me your information or have someone else do that. So let's get to what Robin's been doing. She has been at the forefront of maternal health advocacy in her state, and her efforts recently helped secure a $17,000,000 federal grant to support maternal health initiatives. And we are so excited to hear more about her story and what this funding means for the future of care for women and families in Arkansas. Robin, welcome to the podcast.
Robin Fagala:Thank you, Daniel. I'm really appreciative of you taking the time to share my story. This is not about me. This is really about what I felt was something that needed attention brought to it, and advocating on behalf of not only my physicians and proper compensation, but also for our patients. We have a situation, I've been in healthcare for about twenty six years.
Robin Fagala:I started in dermatology, worked in OB, then went to pediatrics, and now I'm back in OB. Been here for fourteen years, I love what I do, and I'm very passionate about helping people. I think anybody that has come into health care, that had to be probably a big motivating factor. My physicians and my providers share that same view. They believe that good health care should be available to all people.
Robin Fagala:Now I'm not saying I'm an advocate for free health care unless you're doing mission work or working in a pre clinic, nor am I a fan of socialized medicine, but they want to do the right thing morally and ethically, and we believe that is making healthcare available to all people. I grew up with three younger sisters, so I learned how to fight at an early age. I think anybody with siblings understands that. But because of that, I've also had to learn how to come to resolution with problems. There has to be a respectful way to come to to present a problem, and the saying you get more flies with honey than with vinegar, that's really true.
Robin Fagala:You need to be respectful of people when you're bringing a situation to them.
Daniel Williams:Yeah. Let me just jump. I wanted to ask you real quick. Tell us a little bit about Conway OBGYN. It's in Conway, Arkansas.
Daniel Williams:You've been there, I believe, fourteen years. Tell us a little bit about the practice and what your role is there, and then let's get into this grant and the other work you've been doing. But just on your day to day, talk about that.
Robin Fagala:Okay. Conway OBGYN was created and formed in 1980 by doctor Paul McChristian. So we've been here over forty years, and doctor McChristian was the first OB GYN in Conway. He had a vision for Conway. He he actually, his first weekend here was the weekend that the missile silo blew up about an hour north of here.
Robin Fagala:So he got thrust into that spotlight very quickly. Conway is a three city a three college town here in Central Arkansas, just 30 miles north of Little Rock. So we've got a busy practice. We currently have four doctors, one another coming to join us in July, and we have four nurse practitioners. We see a lot of people every single day.
Robin Fagala:Our practice is probably, I would say, sixtyforty percent, 60% OB, forty GYN care. Our Medicaid population is probably, I'd say, twenty five to thirty percent of our
Robin Fagala:patients. That does include gen and OB patients. There are three other clinics, actually four other clinics here in town. It falls to me to, of course, as manager to monitor our financials, our patient demographics, our payer mix, all of that. And as that changes, then we have to react to that and see how that's affecting us financially.
Robin Fagala:Did I answer your question?
Daniel Williams:I think you did. Yeah. You sure did. I appreciate that. And then I'll just follow-up then.
Daniel Williams:And then what do you see as your most important role there at Conway?
Robin Fagala: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 my doctors that I am super protective of my doctors. I believe they are the best doctors in this area, and I'm very proud of our staff. Our staff is exemplary.
Robin Fagala:I would put them up against anybody's staff any day. My main goal is to keep the practice moving forward, to keep us compliant, and to keep us competitive. I joke with my doctors and tell them, hey, I've got your back. I'm taking care of you, and I will let you know when you wanna do things that you just can't do because they're either not they don't study up on health care law and things like that. But if something happens and I tell them, you can't do this, you have they can decide.
Robin Fagala:Are they gonna do this or they're not gonna do this? They have their own free will. They said, and I love you, but I'm not going to jail for you. And they just laugh. Of course, we're not doing anything illegal, but protecting the clinic and keeping us viable, and we want to be known as the place where everybody wants to go.
Robin Fagala: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 like you would treat your own mother, your sister, your aunt, your cousin, that's important to me because these patients are important, Not because they're patients, but just because they are who they are. People are important.
Daniel Williams:Yeah. Thank you for sharing that. Now let's talk about the recent $17,000,000 grant from the Centers for Medicare and Medicaid Services. What was your involvement in that effort, and how did it all come together?
Robin Fagala:I cannot take any credit for that $17,000,000 grant. I would love to be able to tell you I did. But a little background, in 2020, the maternal mortality rate in Arkansas was thirty five point eight deaths per 100,000 live births. And while the rest of the nation averaged twenty three point eight maternal deaths per 100,000 live births. And unfortunately, Arkansas was known as the leader in maternal mortality, and that's not something you wanna be known as the leader for.
Robin Fagala:Every person is important to somebody, and so we need to do what we can to decrease that number. Our governor, Sarah Huckabee Sanders, set up a committee to review this situation, and they worked to come up with interventions and solutions to prevent these deaths. The committee consisted of physicians, maternal fetal medicine physicians, OBGYNs, pediatricians, family practice doctors, other medical professionals, nursing staff. Our surgeon general is doctor Kay Chandler, and she is an OB GYN physician, and she is a delight. She is very passionate about her practice and her consistent care for women.
Robin Fagala:Then we had representatives from Arkansas Foundation for Medical Care. I don't know if other states have groups like AFMC, but this is a group of people that help facilitate things for us as providers, provide educational opportunities, and I worked with Cheryl Hurt on this. And when I first started realizing part of this maternal fetal problem was because we didn't have enough physicians and providers that were willing to take these patients. A big part of that is because in Arkansas, the OBGYN codes, and I created the table of these delivery codes and peri perinatal codes, and just went out and made a table of this is the code, this is how much it costs, and this is what Medicaid reimburses. We had not had an increase in the fees and the reimbursement for those codes since 02/2002 or 02/2003.
Robin Fagala:'20 '3 years, we had not had an increase. Nobody works for what they made in 2023. You can't survive on that. My doctors kept providing care because they believed it was the right thing to do, and the whole time, I'm saying we've got to look at this. Yes, we need to provide care, but something's gotta give.
Robin Fagala:That is a huge reason that people weren't seeing Medicaid patients. At one point, we're in Central Arkansas, and there was not another OB GYN provider that would accept Medicaid patients between Conway and Memphis. Wow. That is a lot of territory. We have OB patient that would come from South Arkansas, Southeastern Arkansas, and come to see us because they couldn't find a Medicaid provider.
Robin Fagala:So I started formulating a plan and shaking some stuff to see what's gonna fall out, and I contacted Cheryl at AFMC and I said, hey, This gotta change. We can't do this. And she said, see what you can do. Over a period of four years, I talked to everybody and anybody that would listen. I was like that little kid that kept grabbing your coat and pulling on it and saying, hey.
Robin Fagala:And I was always kind, but there were times that I was more firm, and it just seemed to be at certain people weren't listening. And I think it was more that the legislatures and the people that set our fees and look at these didn't realize that there was such a big problem. I sent a letter to our governor and to our legislators and explained what was going on, that there was a big push regarding maternal mortality. I felt a big reason was because there was not physician care provided, and the reason for that is because we hadn't had a raise in twenty three years. They actually listened to what I had to say, but I did my research.
Robin Fagala:I contacted SVMIC is our medical malpractice carrier, And they are fabulous.
Robin Fagala:I love our people. I love my rep, Melanie Hilton, Sharon Theriault. They've been wonderful to help me with things through the years. And so I contacted Michael Cash, and Michael has been a big help as well.
Robin Fagala:He asked him to pull some data from MGMA's data dive. They have the access to the full database. And so he pulled data from what parents say? Basically, what the full time employee cost is for our full time employees. We took the mean.
Robin Fagala:We didn't go to the highest level. We took the mean average. He pulled the RVUs for me for the 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 routine delivery. Nine months of care. And our cost, just for our cost, not just a made up number, but with the data, we were losing $951.95 for every Medicaid OB that we accepted.
Robin Fagala:That was everything you have to consider, staff costs, utilities, supplies, everything. And so in my letter, I referenced that. I included the data tables, and I told them the Medicare rate, I think, was like 2,100 and something dollars, and this, the 59,400 code, cost us about $2,161.95 Medicare reimburses $2,018.97 for that procedure code. And when we're taking that kind of loss for every single one of those patients, we can't buy better equipment, we can't hire more staff, which our staff does an amazing job, but they deserve raises, they deserve to have bonuses. We need to be able to buy supplies, and my doctors were the ones that were eating that cost.
Robin Fagala:And I don't believe that we should be required to pay, even though we're not sending out cash money, to pay for that type of outlay. I told them we respectfully asked them as our legislators to find a way to adequately and fairly compensate us, OB GYN procedure codes, and I attached my table, and I didn't even attempt to look at the gynecologic side of things. I was just focusing on OB. And I explained, we're not trying to issue an ultimatum, but we physically for our business, we cannot continue to sustain this kind of loss, and we are going to have to stop taking these Medicaid patients, which is not what we wanna do. We want to provide the care, but we've got to be paid.
Robin Fagala:And I told him I was available to talk, and Kay Chandler, our surgeon general, called me and she said, hey. I've got your letter. I'm taking it straight to the governor. Governor Sanders was very gracious and took the time to go through that and look at it. I don't know exactly the process they went through, but we have received doctor well, governor Sanders made a video or presented and said, we're gonna be getting a 70% increase in our fee schedule.
Robin Fagala:And I thought, woo hoo. I was doing the happy dance in my chair. It just proves you can make a difference. Take the education that you've been given, the educational opportunities that MGMA gives you, use the data dive platform. Pull that data and use that to benefit to your benefit and to prove.
Robin Fagala:When you're an MGMA member, especially if you're certified or if you're a fellow, you know what you're talking about. You've done your research. You've put the time in. I think a lot of times, maybe we don't get the recognition or the credit that we deserve for that, but I'm super proud to be a member of MGMA. I'm so thankful for the educational opportunities that they brought to me.
Robin Fagala:My doctors support me in that, and I have my certification. I don't know if I'm gonna be brave enough to jump out there and get my fellowship, but I am considering it.
Daniel Williams:That's a wonderful story. Now I wanna go back to a couple of items here before we sign off today. You were advocating for these improvements for several years. Oh, yes. It can be it's not instant gratification as we often are people are looking for in today's world.
Daniel Williams:So how did you persevere? What did you do to just stand strong with your convictions here to continue to push the buttons, to connect with people, to make a difference? What was that like during those long stretches where you're just not seeing any traction there?
Robin Fagala:It can be very frustrating. And, yeah, there was a lot of times that you I just felt like this is not making a difference. It's not I'm not getting anywhere. But then I would think again about my clinic. I would think about these patients, and bottom line, Medicaid providers were dropping like flies because of this.
Robin Fagala:And it seemed like nobody could understand why people were not participating. And so every meeting I went to, it didn't matter if it was a region a CAMA regional physician health organization meeting. We have a wonderful PHO, executive director, Bobby Riggs, who is an MGMA member. It didn't matter if it was our state, MGMA, which was a great place. I pulled a lot of support from there, and I would just say, hey, this is what I'm looking at.
Robin Fagala:Do you know anybody? Who could I talk to? Do you have the ear of somebody that I could possibly sneak in, even the side door or the back door, just to make them aware? I don't think that the state was trying to penalize anybody. I just don't think they were aware of the problems.
Robin Fagala:Now I did get a thing yesterday or the day before from the state Medicaid stating that they're creating a panel of medical professionals, administrators to look at Medicaid policy and some changes, and they're asking for volunteers. And so you can fill out an application and submit it and see if they feel like you would be a good fit. So I'm probably gonna do that. I have to run that by my doctors. That's a way reach out to your friends, connect.
Robin Fagala:The MGMA network, go to your meetings, connect with people because that provides you a lot of support.
Daniel Williams:Okay. Last question then. You did go through a process. You alluded to it earlier, but you put together a letter eventually that helped push this over the line. But how did you know where to start?
Daniel Williams:Where did that kind of kernel that you had the passion that this isn't working? You'd looked at Datatype. You'd looked at other analytics. You'd looked at y'all's numbers, saw that you were losing money on each one of those patients there. So where did this all come together where you took it from we have a challenge and a problem?
Daniel Williams:Now I need to get out there and be an advocate to make a difference here. Where'd you talk about that part of it.
Robin Fagala:I had no idea where to start. I really didn't, and I think that's where most people, when they they find a problem and they're not sure where to take it to the next level. Again, I reached out to everybody 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 questions and make known issues.
Robin Fagala:Again, I was talking about AFMC, Cheryl Hurt. Cheryl, what is the she advocates between AFMC and the legislators, and she took my table and my information about two years ago and presented it because the DHS deputy director presents at that state Medicaid meeting every year. And he was the interim director at that time, had no idea. He was appalled. Twenty two, twenty three years, how could you not address this?
Robin Fagala:So they did come up with the idea of doing a rotation every four years. They're rotating, reviewing the fee schedules for a group of providers. It might be neurology and dermatology and peds one year, next year it'd be a different group. Like I said, I reached out to everybody, and I told my doctors, listen, this is my last ditch effort. And I really didn't wanna do this because I didn't feel like it was giving the legislature and everybody the opportunity to respond, but I was considering taking it to the media.
Robin Fagala:You know, contacting our state newspaper and say, hey, we have a problem. Before you do something like that, you need to see if you've exhausted every opportunity to make your presentation to the powers that be. Find your state legislators. Make sure that that you can talk to somebody in the legislature and say, hey. We got a problem.
Robin Fagala:So that's where I went. But your MGMA State Association, there's a lot of people out there, and a lot of these people have the same problem you do, and they have connections too. Exhaust those possibilities. Use that network, and that is one thing MGMA excels at.
Daniel Williams:Alright. Robin Fagala, thank you for joining us on the podcast today.
Robin Fagala:I really appreciate the opportunity to share. You asked me at first what I'm passionate about. My real passion is my grandbabies. Grandbabies and family, but I thoroughly enjoyed being able to share. I'll be glad to send you, like I said, what I've got.
Robin Fagala: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 have built before and help each other get through. That's what we're here to help to do is to help each other.
Daniel Williams:Yeah. Well, we've been joined today everyone by Robin Fagala with Conway OBGYN. We just wanna thank her for the work she's been doing to elevate maternal health in Arkansas. Her work is a powerful example of how advocacy and persistence can make a lasting impact, And I just wanna tune everybody into that, listen to Robin's message, and reach out to that MGMA network where you can make a difference as well. So thank you all for being MGMA podcast listeners.
