Boost­ing Med­i­caid pri­mary doc pay

Pro­posed rate bump sees guarded sup­port

Modern Healthcare - - FRONT PAGE - An­dis Robeznieks

The prospect of states re­ceiv­ing nearly a to­tal of $12 bil­lion for 2013 and 2014 to boost Med­i­caid pay­ments to pri­mary-care physi­cians has been gen­er­ally well-re­ceived, though there is ap­pre­hen­sion over re­turn­ing to cur­rent pay­ment lev­els come Jan. 1, 2015.

The two-year com­mit­ment to boost Med­i­caid rates so they match those for Medi­care was in­cluded in the Pa­tient Pro­tec­tion and Af­ford­able Care Act, and the CMS re­leased its pro­posed rule on how it would im­ple­ment that pay­ment last week. Ac­cord­ing to the 78-page doc­u­ment: “This pro­posed rule is nec­es­sary to pro­mote ac­cess to pri­mary-care ser­vices in the Med­i­caid pro­gram be­fore and dur­ing the ex­pan­sion of cov­er­age that be­gins in 2014,” and state of­fi­cials are con­cerned that with­out the nec­es­sary pri­mary-care work­force in place, in­creased cov­er­age for the pre­vi­ously unin­sured will not trans­late into in­creased ac­cess to care.

Michael Gelder, se­nior health­care pol­icy ad­viser to Illi­nois Gov. Pat Quinn, said dur­ing a forum last week spon­sored by the Robert Wood John­son Foun­da­tion and the As­so­ci­a­tion of Health Care Jour­nal­ists that many fear the Med­i­caid ex­pan­sion could turn into a sit­u­a­tion where “ev­ery­one gets a li­brary card, but there’s not enough books in the li­brary.”

Rachel Reiter, spokes­woman for the Colorado Depart­ment of Health Care Pol­icy and Fi­nanc­ing, said in an e-mail it’s ex­pected that the new fed­eral help will re­sult in a 17.5% in­crease to pri­mary-care providers and an ad­di­tional $9.4 mil­lion into the state’s Med­i­caid sys­tem for those two years.

The Amer­i­can Med­i­cal As­so­ci­a­tion expressed some guarded sup­port for the mea­sure. Dr. Peter Carmel, the AMA’S pres­i­dent, noted in a writ­ten state­ment that Med­i­caid pay­ments are too low and have not kept pace with the costs of care.

The pro­posed rule calls for in­creas­ing pay­ment to fam­ily medicine physi­cians, in­ternists and pe­di­a­tri­cians, and all re­lated sub­spe­cial­ties rec­og­nized by the Amer­i­can Board of Med­i­cal Spe­cial­ties. It pro­poses up­dat­ing pay for vac­ci­na­tions, which has re­mained flat since 1994, and it in­cludes pay­ments for eval­u­a­tion and man­age­ment ser­vices cur­rently not cov­ered un­der Medi­care, such as com­pre­hen­sive pre­ven­tive medicine ser­vices for new pa­tients; risk-fac­tor re­duc­tion and be­hav­ior-change coun­sel­ing; and eval­u­a­tion and man­age­ment tasks not done in a per­son-to-per­son visit.

The 132,000-mem­ber Amer­i­can Col­lege of Physi­cians, the na­tion’s largest med­i­cal-spe­cialty so­ci­ety rep­re­sent­ing in­ternists and in­ter­nal medicine stu­dents, re­leased a state­ment at­trib­uted to Dr. David Bron­son, its pres­i­dent, which said the or­ga­ni­za­tion was “par­tic­u­larly pleased” and en­cour­aged by the pro­posed rule. He added, how­ever, that the ACP will be urg­ing Congress to ex­tend the pro­gram.

Dr. Glen Stream, pres­i­dent of the Amer­i­can Academy of Fam­ily Physi­cians, which has al­most 106,000 mem­bers, de­scribed the pro­posed rule and tem­po­rary pay in­crease as “over­all, a very pos­i­tive thing,” es­pe­cially in that it put new dol­lars into the physi­cian pay­ment pool where pre­vi­ously, the only way one group of physi­cians re­ceived more money was for an­other group to re­ceive less.

Stream said the in­crease should im­prove par­tic­i­pa­tion in the Med­i­caid pro­gram, but also that “its im­pact would be lost rather quickly” if not re­newed. He also noted that the tem­po­rary in­crease could pro­vide two years of more ev­i­dence of how in­creas­ing spend­ing on pri­mary-care re­sults in lower over­all costs.

El­iz­a­beth Wi­ley, pres­i­dent of the Amer­i­can Med­i­cal Stu­dent As­so­ci­a­tion, also was pos­i­tive—even though the in­creases may no longer be in ef­fect when she ex­pects to en­ter the pri­mary-care work­force in July 2016. “I think this is a first step to­ward mov­ing Med­i­caid re­im­burse­ment rates in the right di­rec­tion,” said Wi­ley, who will re­ceive her med­i­cal de­gree from Ge­orge Washington Univer­sity School of Medicine and Health Sci­ences on May 20.

She noted that there are very few new pri­mary-care doc­tors go­ing into solo or small­group prac­tices, and that most are join­ing large mul­tispe­cialty groups where pri­mary care is of­ten a money loser for the or­ga­ni­za­tion.

Sen. Or­rin Hatch (R-utah), how­ever, is­sued a news re­lease ques­tion­ing the value of the tem­po­rary in­crease. “It’s non­sen­si­cal to think a tem­po­rary, two-year bump in pay will ac­tu­ally at­tract and re­tain doc­tors to the Med­i­caid pro­gram un­less the White House thinks Congress will keep ex­tend­ing these higher pay­ment rates in per­pe­tu­ity,” Hatch said in the re­lease. “Ev­ery year, Congress has to stop Medi­care physi­cian pay­ment rate cuts and this pro­posed reg­u­la­tion will now cre­ate the same dilemma un­der the Med­i­caid pro­gram.”

Michelle Mcomber, ex­ec­u­tive vice pres­i­dent and CEO of the Utah Med­i­cal As­so­ci­a­tion, said Hatch has a valid point. If the fed­eral gov­ern­ment can’t pro­vide a long-term guar­an­tee for Medi­care pay­ment, she said, there is not much op­ti­mism for Med­i­caid.


The pro­posed rule calls for up­dat­ing pay for vac­ci­na­tions, which has been flat since 1994.

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