Medicaid Expansion Leaves Physicians in A Lurch

by Phil C. Solomon on March 17, 2013

in Medicare - Medicaid

Medicaid – Obamacare Pay Raise of 73% For Doctors Is Delayed

MedicaidIs it any surprise that pay raises for physicians are delayed beyond the timeline set by the Affordable Care Act? How can anyone expect the new legislation to roll out as planned since the reinvention of our healthcare system is so enormous? The physicians that practice in the States who opted to participate in the expanded Medicaid pool were supposed to have reimbursement rises to offset the anticipated increase in Medicaid patient volume.

Many of the sweeping changes have seen some positive outcomes, even those programs such as the re-admission penalties for hospitals have seen positive effects. The latest news is Medicare is reducing some of the hospital’s penalties below the 1% maximum they can assess. That is good news for providers.

This is a complex healthcare world we live and work in. There is an old saying that sums up our healthcare system today, changes we have experienced so far and the anticipated changes in the future, “if you don’t like what you see now, stick around a while, it’s bound to change”! PCS

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Primary care doctor payments for treating Medicaid patients, set to rise 73 percent on average, have been delayed due to the complexities of implementing the Affordable Care Act. (Photo credit: Wikipedia)

A huge pay raise promised under the Affordable Care Act for primary care doctors who treat the nation’s poor covered by Medicaid health insurance is nearly three months behind schedule and may take another three months before it kicks in, state Medicaid directors say.

Under the health law, a primary care doctor – a family physician, a pediatrician or an internist – who treats a Medicaid patient will see their reimbursement rise to the level of the Medicare health insurance program for the elderly for scores of primary care services. Doctors do have to apply to their state Medicaid programs and meet certain criteria in part proving that they have historically treated certain numbers of Medicaid patients.

Though the pay increase will vary because Medicaid rates differ from state to state, the average pay increase will be about 73 percent given Medicare last year paid on average 66 percent of what Medicare pays for certain primary care services, according to a Henry J. Kaiser Family Foundation study. Doctors in some states could see payment increases of 100 percent or more.
The idea behind the pay increase, which is funded by federal dollars for two years, is to get more doctors to accept Medicaid patients and prevent other physicians from dropping out of a government program that hasn’t been well funded. Amid a primary care doctor shortage, eligible patients will need all of the doctors they can get given the health law expands Medicaid coverage to millions more Americans effective Jan. 1, 2014 for participating states.

Because Medicaid is funded via a match of funds from states and the federal government, cash-strapped states that have cut from their programs in also lost federal dollars, allowing payment rates to fall far behind.

“The purpose of the increase in Medicaid physician fees for primary care is to encourage greater Medicaid participation among physicians as the program expands in 2014 and demand for care increases,” the Kaiser report said. “If the enhanced payment rates succeed in increasing physician participation and beneficiary access as intended, interest in extending the higher Medicaid rates beyond 2014 is likely to be high.”

But the Obama administration says the checks will eventually reach doctors and payments will be retroactive to Jan. 1 of this year so physicians who are approved to participate in their states will get what they are due.

“The Medicaid enhanced payments for primary care physician fee was made possible by the Affordable Care Act and is in full effect for calendar years 2013 and 2014,” a spokesman for the Centers for Medicare & Medicaid Services says. “States are moving quickly to implement the higher payment and a number of states have already submitted State Plan Amendments (SPAs) which will permit federal funding to flow to states for the increases. In addition to submitting the required SPAs, states are also in the process of reprogramming their claims processing systems to pay at the appropriate, higher rates. CMS has made it very clear that states must make enhanced payments to eligible providers retroactive to January 1, 2013.”

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