Booster shot

The prospect of states receiving nearly a total of $12 billion for 2013 and 2014 to boost Medicaid payments to primary-care physicians has been generally well-received, though there is apprehension over returning to current payment levels come Jan. 1, 2015.

The two-year commitment to boost Medicaid rates so they match those for Medicare was included in the Patient Protection and Affordable Care Act, and the CMS released its proposed rule on how it would implement that payment last week. According to the 78-page document: “This proposed rule is necessary to promote access to primary-care services in the Medicaid program before and during the expansion of coverage that begins in 2014,” and state officials are concerned that without the necessary primary-care workforce in place, increased coverage for the previously uninsured will not translate into increased access to care.

Michael Gelder, senior healthcare policy adviser to Illinois Gov. Pat Quinn, said during a forum last week sponsored by the Robert Wood Johnson Foundation and the Association of Health Care Journalists that many fear the Medicaid expansion could turn into a situation where “everyone gets a library card, but there's not enough books in the library.”

Rachel Reiter, spokeswoman for the Colorado Department of Health Care Policy and Financing, said in an e-mail it's expected that the new federal help will result in a 17.5% increase to primary-care providers and an additional $9.4 million into the state's Medicaid system for those two years.

The American Medical Association expressed some guarded support for the measure. Dr. Peter Carmel, the AMA's president, noted in a written statement that Medicaid payments are too low and have not kept pace with the costs of care.

The proposed rule calls for increasing payment to family medicine physicians, internists and pediatricians, and all related subspecialties recognized by the American Board of Medical Specialties. It proposes updating pay for vaccinations, which has remained flat since 1994, and it includes payments for evaluation and management services currently not covered under Medicare, such as comprehensive preventive medicine services for new patients; risk-factor reduction and behavior-change counseling; and evaluation and management tasks not done in a person-to-person visit.

The 132,000-member American College of Physicians, the nation's largest medical-specialty society representing internists and internal medicine students, released a statement attributed to Dr. David Bronson, its president, which said the organization was “particularly pleased” and encouraged by the proposed rule. He added, however, that the ACP will be urging Congress to extend the program.

Dr. Glen Stream, president of the American Academy of Family Physicians, which has almost 106,000 members, described the proposed rule and temporary pay increase as “overall, a very positive thing,” especially in that it put new dollars into the physician payment pool where previously, the only way one group of physicians received more money was for another group to receive less.

Stream said the increase should improve participation in the Medicaid program, but also that “its impact would be lost rather quickly” if not renewed. He also noted that the temporary increase could provide two years of more evidence of how increasing spending on primary-care results in lower overall costs.

Elizabeth Wiley, president of the American Medical Student Association, also was positive—even though the increases may no longer be in effect when she expects to enter the primary-care workforce in July 2016. “I think this is a first step toward moving Medicaid reimbursement rates in the right direction,” said Wiley, who will receive her medical degree from George Washington University School of Medicine and Health Sciences on May 20.

She noted that there are very few new primary-care doctors going into solo or small-group practices, and that most are joining large multispecialty groups where primary care is often a money loser for the organization.

Sen. Orrin Hatch (R-Utah), however, issued a news release questioning the value of the temporary increase. “It's nonsensical to think a temporary, two-year bump in pay will actually attract and retain doctors to the Medicaid program unless the White House thinks Congress will keep extending these higher payment rates in perpetuity,” Hatch said in the release. “Every year, Congress has to stop Medicare physician payment rate cuts and this proposed regulation will now create the same dilemma under the Medicaid program.”

Michelle McOmber, executive vice president and CEO of the Utah Medical Association, said Hatch has a valid point. If the federal government can't provide a long-term guarantee for Medicare payment, she said, there is not much optimism for Medicaid.