AAFP Works to Ensure Patient Access to Medicaid

Enhanced Physician Payment Key to Success

January 19, 2016 03:11 pm News Staff

Medicaid beneficiaries need access to primary care physicians, and the AAFP is continuing its efforts to ensure that Medicaid physician payment rates are high enough to encourage physicians to consider participating in the program.

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Hence, the AAFP's recent letter to HHS Secretary Sylvia Burwell and CMS Acting Administrator Andy Slavitt that provided family physicians' input on a final rule(www.gpo.gov) published in the Nov. 2 Federal Register, which asked for stakeholder comment on how best to measure Medicaid beneficiaries' access to health care.

In the Dec. 24 letter,(4 page PDF) AAFP Board Chair Robert Wergin, M.D., of Milford, Neb., expressed disappointment that CMS had failed to adopt the Academy's 2011 recommendation to develop a "consistent national approach" to measuring access to care.

"Instead, after more than four years, CMS merely requests further feedback on how to measure access to care. This lack of progress is a major concern," said Wergin.

He suggested that CMS do more to implement methods and procedures related to the utilization of -- and payment for -- services available under Medicaid fee-for-service and Medicaid managed care plans.

Story Highlights
  • As part of its ongoing efforts to safeguard patients' access to Medicaid services, the AAFP told CMS that enhanced physician payment is a key priority.
  • In a recent letter, the AAFP expressed disappointment that CMS had made little progress during the past four years in developing a consistent national approach to measuring access to care.
  • AAFP Board Chair Robert Wergin, M.D., expressed concern about the long-term sustainability of primary care practices that receive Medicaid payments that are far less than those of Medicare and commercial plans.

"We believe CMS needs to exert oversight that will prevent reductions in access to care -- especially for Medicaid beneficiaries to their primary care physicians," said Wergin.

Medicaid patients "deserve meaningful access to the health care services that are within the scope of covered benefits," said Wergin.

He noted that the Patient Protection and Affordable Care Act (ACA) provided primary care physicians with temporary relief from inadequate Medicaid payments.

Unfortunately, that program expired in 2015, said Wergin. He referenced a study published nearly a year ago(www.nejm.org) in The New England Journal of Medicine that concluded that the availability of primary care appointments in Medicaid-participating practices increased during those two years. Furthermore, "States with the largest increases in availability tended to be those with the largest increases in reimbursements," he added.

Wergin reminded CMS of the 2 percent sequestration cut in primary care Medicare payments that took effect in 2013 and lamented the pending 2016 expiration of the Medicare Primary Care Incentive Program.

"The AAFP continues to support health care coverage for all," said Wergin. But solo, small and medium-sized primary care practices already operate on narrow financial margins.

"We are, therefore, concerned about the long-term sustainability of primary care practices whose Medicaid payment is less than that of Medicare and commercial plans," said Wergin.

It's important to measure and publicly report Medicaid physician payments rates and to apply transparent payment adjustment methodologies, he noted. However, matching Medicare and Medicaid rates for primary care physicians would do more than anything else to ensure that Medicaid patients have access to medically necessary care.

AAFP Member Survey Illustrates Medicaid Participation

According to findings from the AAFP's 2014 Practice Profile Survey -- which tallied responses of 532 family physicians who indicated they spent a majority of their time in clinical practice and patient care -- about 16 percent of patients in an average family physician's patient panel were covered by Medicaid.

Furthermore, about 60 percent of family physicians who responded to the survey said they accepted new Medicaid patients. About 10 percent stopped taking new Medicaid patients in the 12 months prior to the survey, and about 16 percent stopped accepting new Medicaid patients more than 12 months prior to the practice survey.

"We call on CMS to mandate that states use a baseline of 2014 for primary care payments," said Wergin. He argued that doing so would highlight the actions individual states took regarding Medicaid payment rates after the end of the two-year implementation of the rate increase prompted by the ACA.

Let's "reward those states" that ultimately kept their rates at least in line with Medicare physician payment, he urged.

Regarding CMS' request for comments about whether exemptions based on state Medicaid program characteristics should be granted, Wergin suggested that CMS avoid such exemptions -- with one exception.

"If states reimburse primary care service at or above Medicare rates, then in these favorable circumstances, CMS should offer states the opportunity to bypass further reporting requirements," said Wergin.

In the same letter, the AAFP offered detailed responses to a number of CMS questions about how to ensure patient access to Medicaid, including the

  • pros and cons of requiring a national core set of access-to-care measures and metrics,
  • primary indicators of patient access to care in the Medicaid program,
  • wisdom of CMS-set thresholds for Medicaid access to care and how those would be utilized, and
  • advantages and disadvantages of employing either a complaint resolution process or a formal appeals hearing to hear patient concerns about access to care.

Related AAFP News Coverage
AAFP Map Tracks Progress on Medicaid Parity Increase by State
(11/7/2013)

More From AAFP
AAFP Statement: AAFP and Other Medical Organizations Call for Two-Year Extension to Medicaid Parity Provision
(6/11/2014)


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