• In The Trenches

    It’s Time to Double Down on Payment Parity

    In the year since COVID-19 began hammering at the foundation of U.S. primary care, the Academy has lobbied nonstop for legislation and policy to limit members’ economic damage and equip practices to meet an enormous, historic medical challenge. In three words, we’ve been working to stabilize, strengthen and sustain the specialty.

    coins on scale

    Two related words are at the heart of what we’re doing on Capitol Hill right now, as the country turns a political corner and vaccination efforts lurch forward.

    One of the words is payment.

    To not only return comprehensive family medicine practices to pre-pandemic safety but also enable them to prosper, we must aggressively seek payment reform. Or, at minimum, payment restoration — a short trip back in time to the period when the Patient Protection and Affordable Care Act mandated equivalent Medicare and Medicaid payment rates for primary care services. You’ll recall this era as one in which patient access improved. 

    That’s why last week we asked members of the congressional committees writing the legislation that will make up the $1.9 trillion American Rescue Plan to get in the time machine and take primary care back to the future. Specifically, we said: “The AAFP urges Congress to pass legislation to raise Medicaid payment rates for primary care services to at least Medicare rates.”

    The difference is stark. Medicaid pays, on average, a scant 66% of the Medicare rate for primary care services. In some states, the Medicaid rate is 33% of Medicare’s.

    The pay disparity between Medicaid and other payers was already unsustainable. In a pandemic, it’s a sledgehammer. So, yes, we want at least Medicare rates. Because the restoration of U.S. health at large is at stake.

    Roughly 6 million new enrollees in Medicaid and the Children’s Health Insurance Program last year fed a booming demand for primary care. That need is acute among the Black and Hispanic patients who have been disproportionately affected by COVID-19 and also make up a majority of Medicaid enrollees. A study just published in Health Affairs offers a grim analysis of where these trends are taking us.

    Inadequate Medicaid reimbursement has made the challenge of that surge an existential one for a number of primary care practices — and for family medicine’s future. It’s hard for the specialty to recruit and retain physicians when they know from the start that their work will be literally undervalued.

    That’s why the other word of the moment is workforce.

    The leaders behind family medicine’s America Needs More Family Doctors: 25 x 2030 collaborative have always identified the need for payment transformation among the factors requiring attention. That long-term project was well underway when COVID-19 swung its mallet at family medicine practices — and, by extension, the primary care pipeline. We aren’t going to get the family physicians needed in the coming decades if practices are too diminished to take residents, or if those practices are simply gone.

    When the AAFP recently sent the Biden administration detailed recommendations for strengthening the primary care workforce, we said that right-sized primary care valuation would be crucial to that end. Payment policies that “reward the continuous, comprehensive care that family physicians provide,” as we put it, really are the way through the pandemic and well into the future.

    Expect to see us engage Congress in the coming weeks to press our payment and workforce goals.


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