Med­i­caid has bad 2015 news for pri­mary-care docs

Modern Healthcare - - THE WEEK AHEAD - —Paul Demko

The new year will bring un­wel­come tid­ings to doc­tors who treat Med­i­caid pa­tients—steep pay­ment cuts.

Be­fore ad­journ­ing, Congress did not ex­tend Med­i­caid rate in­creases for pri­mary-care ser­vices to bring those rates to par­ity with Medi­care rates, a bump man­dated by the Pa­tient Pro­tec­tion and Af­ford­able Care Act. That tem­po­rary two-year hike, de­layed in many states by bu­reau­cratic sna­fus, re­sulted in $5.6 bil­lion in ad­di­tional pay­ments through June.

The higher rates were in­tended to en­tice more doc­tors to serve the ex­panded pool of Med­i­caid ben­e­fi­cia­ries un­der the health­care re­form law. Pre­vi­ously, Med­i­caid pri­mary-care rates were shown to be on av­er­age 58% of Medi­care rates. Stud­ies have found that Med­i­caid ben­e­fi­cia­ries dis­pro­por­tion­ately live in ar­eas with a short­age of pri­mary-care doc­tors. The av­er­age Med­i­caid pay­ment re­duc­tion in 2015 will be 42.8%, ac­cord­ing to an Ur­ban In­sti­tute anal­y­sis. But doc­tors in states in­clud­ing Cal­i­for­nia, Florida and New York will see cuts of more than 50%.

Some states are step­ping in to pick up the slack. At least 15 states have in­di­cated they will cover some of the cost to main­tain the Medi­care-par­ity rates, ac­cord­ing to the Kaiser Fam­ily Foun­da­tion. But the pay bump will go away in at least two dozen other states.

Stephen Zuck­er­man, a se­nior fel­low at the Ur­ban In­sti­tute, said states with higher pay­ment rates tra­di­tion­ally have got­ten more doc­tors to treat Med­i­caid ben­e­fi­cia­ries. But it’s un­clear whether the ACA pay­ment in­creases had a sim­i­lar ef­fect. While data are not yet avail­able to eval­u­ate the ef­fec­tive­ness of the pay hikes, “Some of the early ev­i­dence, at least anec­do­tally, is pos­i­tive,” he said.


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