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Tuesday Jul 01, 2014

Primary Care: 'A Matter of Priorities'

Tucked away inside the Patient Protection and Affordable Care Act (ACA) is a provision that is one of the law's more important policies aimed at improving the quality of care for individual patients and controlling the overall costs of health care for the government. Section 1202 of the ACA requires that Medicaid compensate primary care physicians at 100 percent of Medicare payment rates for a defined set of primary care services in 2013 and 2014. This provision is set to expire on Dec. 31, and all family physicians participating in the Medicaid program will see cuts -- dramatic cuts in many cases -- in their Medicaid payments.  

Why is this provision so important? Because it takes the necessary steps to ensure that health care coverage is met with access to primary care physician services. In other words, it makes health insurance a tangible item for millions of Medicaid beneficiaries and not health care coverage in name only.  

It's no secret that patients who have health care coverage and a usual source of care have better outcomes than those who lack one or both. It also is no secret that Medicaid, historically, has been an extremely poor payer.

For decades, states have decreased payments to physicians and other health care professionals as a means, in part, to finance more expansive benefit packages for beneficiaries. Physician participation rates reflect the low payment rates, and access to care for Medicaid patients has been challenging (or non-existent) in many areas of the country.

In the good news category, the ACA provision that increased Medicaid payment for primary care services has, apparently, single-handedly solved our nation's primary care shortage. It is amazing how many physicians are providing “primary care” to Medicaid patients and claim to deserve this bonus payment. If you listen to other physician organizations tell it, there are about 800,000 physicians providing primary care in the United States.

The AAFP agrees that a number of physician specialties provide some primary care services just as a large percentage of family physicians provide some cardiology services. The difference is family physicians don’t clamor to be called cardiologists. Just because a physician provides some “primary care services” does not mean that they provide continuous and comprehensive primary care – especially if their discipline ends in “ologist.”   

According to Merriam Webster, “ologist” means “specialist.”    

Mark Miller, Ph.D., executive director of the Medicare Payment Advisory Commission (MedPAC), was asked during a recent House Ways and Means Committee hearing about the inclusion of physicians who provide primary care services in incentive payment programs. His answer was aimed at the Medicare program, but it is completely applicable to the Medicaid payments and closely aligns with the AAFP’s views on the issue.   

“There is great concern that the procedural side of the fee schedule is overvalued," he said. "If you go to the cognitive side there is concern that that is undervalued. … But if you have to pick priorities, and there’s limited amounts of dollars, then the commission’s point is: The first concern is the primary care sets of services. … So it’s not that the commission completely disagrees; it’s more a matter of priorities.

Well stated, Dr. Miller. The AAFP shares these priorities, and we are working hard to ensure that this policy regarding Medicaid parity continues and allows millions of people to realize the goal articulated in the beginning of this article -- making sure that their health care coverage is met with access to care.

Since 2012, the AAFP has been working to build support for the extension of this important policy. This policy was a focal point of AAFP’s annual Family Medicine Congressional Congress, at which Academy members met with more than 115 Members of Congress and Senators to urge extension of the payment policy for at least two years. Additionally, we have partnered with other physician and patient advocacy organizations to form a coalition aimed at developing legislation that would extend the program and better define eligibility and covered services. In recent weeks, the AAFP has engaged with congressional staff to assist in the drafting of legislation that would extend Medicaid parity payments for at least two years. This process is far from complete, and there is much work to do, but we are pleased that there is movement.

Here is what needs to happen to successfully extend this program. First, we have to articulate to legislators and congressional staff why this program should be limited to true primary care physicians trained in comprehensive primary care. AAFP staff and leaders will handle this task. Second, we need to demonstrate the impact this policy is having on patients and physicians, and this is an area where family physicians can make a big difference in our advocacy efforts. We need your assistance. The AAFP is collecting information on how increased Medicaid payments are improving patient access to primary care services. Your stories can enhance the Academy's advocacy efforts.  Please visit our Speak Out page and submit your story by Aug. 1.  

Wonk Hard
We are No. 11! The Commonwealth Fund has released “Mirror, Mirror on the Wall, 2014 Update: How the U.S. Health Care System Compares Internationally.”(www.commonwealthfund.org)

So, how did we do? According to the report, “Among the 11 nations studied in this report -- Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States -- the U.S. ranks last, as it did in the 2010, 2007, 2006 and 2004 editions of Mirror, Mirror.”  It is worth noting that countries that prioritize primary care tend to be at the top of this list.

Posted at 09:00AM Jul 01, 2014 by Shawn Martin

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ABOUT THE AUTHOR



Shawn Martin, AAFP Senior Vice President of Advocacy, Practice Advancement and Policy.

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