While many administrators spend their careers coping with the inequities of systems like reimbursement schedules, one individual’s dedicated, grassroots efforts can indeed result in a huge difference for the larger healthcare industry.
In this episode of the MGMA Member Spotlight podcast, MGMA senior editor Daniel Williams spoke with Robin Fagala of Conway OB-GYN in Conway, Arkansas. Fagala was instrumental in a four-year advocacy project which ultimately helped produce a $17 million federal grant focused on improved maternal health in the state.
Fagala says MGMA’s resources and community played a huge role in the win, which helped overhaul existing state Medicaid fee schedules and produce more equitable compensation for practices and better patient-focused services for her clients.
Responding to an Urgent Need
As Fagala explains, the Conway OB-GYN group has been operating since 1980, with five doctors and four nurse practitioners. It’s a busy practice with about 25% to 30% Medicaid patients, and for many years had become one of the only providers accepting Medicaid patients in a large region between Central Arkansas and Memphis.
“I’m super-protective of my doctors, and I believe they are the best in this area – and our staff is exemplary,” she says. “My main goal is to keep the practice moving forward, to keep us compliant and competitive. I tell my doctors, ‘I’ve got your back, I’m taking care of you.”
An unpleasant reality for the local OB/GYN community, however, was the fact that Arkansas had the highest maternal mortality rate in the country in 2020, with 35.8 deaths per 100,000 live births. In an effort to change those numbers, Fagala began to examine the unique issues facing the state. She discovered a major discrepancy in outdated Medicaid coding, which was contributing to severe limitations in care for Medicaid patients.
“I first started realizing part of this problem was because we didn’t have enough physicians and providers who were willing to take these patients because of those Medicaid codes,” she says.
“We had not had an increase in fees and the reimbursement for 22 years, despite inflation increasing approximately 70%. My doctors kept providing care because they believed it was the right thing to do, but the whole time, I was saying, ‘we’ve got to look at this. This has gotta change.’”
Using MGMA Data to Illustrate the Problem
Over a four-year period, Fagala worked to raise awareness of the issue. While attending their meetings of the state Medicaid division, Fagala said she was told it might institute an overview of specialty codes such as OB/GYN every four years, but other response was muted.
She then decided to do her own in-depth research, using information from MGMA’s Data Dive and input from malpractice and insurance providers to compare reimbursement data to actual operating costs. Those hard numbers demonstrated a serious systemic disconnect.
“I was able to take that information and calculate that Medicaid was paying us just $1,210 for a routine vaginal delivery and nine months of care, and that we were losing $951.95 for every Medicaid OB that we accepted. My doctors were the ones that were eating that cost. When we’re taking that kind of loss, we can’t buy better equipment and we can’t hire more staff.”
Letters Made the Difference
Armed with that MGMA data, Fagala further compiled procedure code tables, cost analyses and comparative benchmarks. In January 2025, she sent letters to the state Surgeon General, legislators and the Arkansas Foundation for Medical Care, illustrating the impacts of outdated compensation. She says she was careful to strike the right tone in her communications.
“We respectfully ask that you, as our state legislature, find a way to adequately and fairly compensate the OB/GYN procedure codes for providers in Arkansas,” the letter stated. “In no way are we trying to issue an ultimatum. We are simply stating our issues and gross pay discrepancy.”
Fagala says that by rationally explaining her practice’s business case – and the reality that continued losses were not sustainable and would mean inability to take more Medicaid patients – it produced an enthusiastic response from Surgeon General Kay Chandler, an OB-GYN herself, who passed the information directly to Arkansas Governor Sarah Huckabee Sanders.
Major Results for Providers
To Fagala’s delight, Sanders helped negotiate a 70% increase in the state’s OB Medicaid fee schedule, which came in concert with a larger $17 million CMS grant to support better maternal health efforts statewide.
The change, which will allow clinics such as Conway OB-GYN and others to more safely and effectively serve mothers and children across Arkansas, illustrates the impact a dedicated individual can have on a broader healthcare issue. And, Fagala adds, the value that organizations such as MGMA play in empowering their membership.
“It just proves you can make a difference,” she says. “Take the educational opportunities that MGMA give you, pull that data and use that to prove that you know what you’re talking about. You’ve done your research and you’ve put your time in.”
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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