Regarding “CMS details Medicaid primary-care payments boost”:

The Patient Protection and Affordable Care Act specified that Medicaid would pay primary-care physicians (PCPs) at the same level as Medicare. So this is a first positive step. But it is clearly not sufficient.

PCPs have for a decade or more been working in on a nonsustainable business model—one in which reimbursements from Medicare and commercial insurance have been essentially flat while office costs have risen substantially. In response, PCPs are seeing more patients for less time each, which is not good for those with chronic illnesses. Or the PCP looks to be employed by the local hospital or just stops accepting insurance altogether and either asks the patient to pay on a per-visit basis out of pocket or enters into a retainer-based practice arrangement.

Graduates of medical schools can see the problem and thus choose to enter a specialty instead. Today America has about 30% PCPs and 70% specialists—just the reverse of most other developed countries. Unless Medicare—and commercial insurance—pays PCPs a more reasonable rate and specifically reimburses for chronic-care coordination, the problem will persist. Just raising Medicaid to Medicare reimbursement rates is definitely not sufficient.

Dr. Stephen Schimpff
Columbia, Md.