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Wednesday Dec 17, 2014

Medicaid Cuts Threaten Primary Care Practices, Access to Care

The year is ending with bad news regarding physician payment, and pending cuts may affect patients' access to care.

Section 1202 of the Patient Protection and Affordable Care Act (ACA) increased Medicaid payments for specified primary care services to Medicare payment levels for certain primary care physicians in 2013 and 2014. The provision was designed to help improve access for the significant and increasing number of Americans who are covered by Medicaid, and states received an estimated $12 billion to bolster their Medicaid primary care delivery systems during those two years. 

© 2014 Sheri Porter/AAFP

Here I am examining a young patient. Congress' recent failure to extend Medicaid parity payments for primary care will hurt primary care practices and hinder our ability to care for Medicaid patients.

More than half the states(kff.org) have agreed to expand their Medicaid programs, and nationally, Medicaid enrollment has increased by 7.5 million people since the fall of 2013. But with payment rates for Medicaid scheduled to revert to 2012 levels on Jan. 1, will the newly insured still be able to find care?

When the American College of Physicians surveyed its members(www.acponline.org) earlier this year, 40 percent of respondents said they would accept fewer Medicaid patients in 2015 if the parity payments stopped, and 6 percent said they would stop participating in Medicaid completely if that scenario were to occur.

The reaction isn't hard to understand. On average, Medicaid pays physicians less(kaiserhealthnews.org) than 60 percent of what Medicare pays for primary care services, and that gap discourages many primary care physicians from treating Medicaid patients. In fact, when the ACA became law in 2010, 36 percent of family physicians surveyed by the AAFP were not accepting new Medicaid patients because of low reimbursement rates, and 20 percent of our members surveyed were not seeing any Medicaid patients at that time.

Unfortunately, with only a two-year period in which outcomes can be considered -- combined with delays in the implementation process -- it is difficult to judge how much of an impact the parity payments made on access. Physicians were asked to expand access to their practices while facing the stark reality that they might have to either accept reduced payment for treating those patients or turn their backs on those new patients after a relatively short time. Sadly, that choice will soon be at hand unless the 114th Congress acts when it convenes in January.

The good news -- for some -- is that more than a dozen states(kff.org) have indicated they will maintain Medicaid parity payments even without federal funds. From these states, we may be able to better judge how physician payment affects patient access and outcomes. A much larger number of states, however, have said they will not extend Medicaid parity.

The pending payment cuts will vary from state to state, but on average, Medicaid payment for primary care will fall 42.8 percent. The largest cut would be in Rhode Island, with a 67 percent drop, while physicians in California, New York, New Jersey, Florida and Pennsylvania would all see reductions of more than 50 percent.

Unfortunately, many states will have physicians who are unable to keep their doors open to Medicaid patients because of low reimbursement rates. This will once again force patients to get the wrong care in the wrong place at the wrong time, utilizing emergency rooms for both acute and chronic care issues. The goal of our advocacy efforts on this issue has been to ensure that patients get the right care, in the right place, at the right time, and from the right person. That means ensuring access to primary care, where health issues can be identified and treated before they progress too far down the clinical pathway.

Will the end of parity payments affect the number of Medicaid patients in your practice?

Reid Blackwelder, M.D., is Board chair of the AAFP.

Posted at 02:06PM Dec 17, 2014 by Reid Blackwelder, M.D.

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