Reform Update: Primary-care docs resist end to Medicaid payment boost

A mix of 21 physician associations and healthcare organizations signed on to a letter to congressional leaders (PDF) seeking an extension of the Patient Protection and Affordable Care Act's two-year provision equalizing Medicaid and Medicare payments for primary-care services.

Signers included the American Academy of Family Physicians and the American College of Physicians internal medicine society along with organizations such as Downers Grove, Ill.-based Advocate Health Care and Knoxville, Tenn.-based physician outsourcing and staffing firm TeamHealth.

According to the letter, almost half of births in the U.S. are covered by Medicaid, so the letter requests that physicians providing obstetrics and gynecology services also be considered for enhanced Medicaid payments.

The enhanced payments for primary care are set to expire Dec. 31. The program went in effect Jan. 1, 2013, but because of the lateness of CMS rules and guidance, states did not have their programs implemented until months later and most of the additional payments for 2013 were made retroactively.

“Our goal is to ensure that Medicaid patients have access to a primary-care physician,” according to the letter. “Strong evidence demonstrates that sustaining the primary-care payment policy in Medicaid through at least the end of 2016 is critical to ensuring access to primary care, leading to better quality of care for patients and decreased costs for the states.”

Dr. Reid Blackwelder, president of the AAFP, said in a news release that extending the program would increase access and result in better patient outcomes and lower costs.

Doctors are concerned that they will not be able to flag as “disputed” public reports generated by the federal government's Open Payment Program, which was initiated by the Sunshine Act provision of the Affordable Care Act.

The CMS received 38 comments from organizations seeking clarification on how or if reports will be marked if doctors disagree with information on the size of “transfers of value” group purchasing and drug and device manufacturers said they made to doctors. GPOs and manufacturers are required to reports transfers of $10 or more.

“The AAMC is deeply concerned that these draft notifications suggest that applicable manufacturers or applicable GPOs may simply dismiss an initiated dispute without resolution or the express agreement by a covered recipient,” Ann Bonham, chief scientific officer of the American Association of Medical Colleges (PDF), wrote in a letter to CMS Administrator Marilyn Tavenner.

Physicians are not required to submit anything to the CMS. The reporting burden falls entirely on the GPOs and manufacturers, but the American Medical Association and the California Medical Association expressed concern that inaccurate reports could lead to “economic and reputational harm” for doctors.

“A number of CMS officials have suggested that physicians are not subject to any penalties under the Open Payments Program and, thus, should not be concerned about inaccurate reports,” wrote Dr. Richard Thorp, president of the California Medical Association (PDF), in a letter to Tavenner. “Congress did not intend that the agency would simply rubber stamp and publish reports submitted by manufactures/GPOs that may or may not be accurate, and that could be, in fact, defamatory. Physicians are uniquely positioned to be highly motivated to ensure that their report is accurate since inaccurate reporting may result in loss of employment, disciplinary action, reputational harm, loss of associations and affiliations, other financial sanction, and even civil and criminal liability.”

The American Medical Association House of Delegates voted to lobby Congress to raise the threshold for reporting transfers of value from $10 to $100.

Sen. Jay Rockefeller (D-W.Va.) has introduced a bill to extend funding for the Children's Health Insurance Program, which is scheduled to expire next year.

The Affordable Care Act extended the life of CHIP through Oct. 1, 2015, and members of the Medicaid and CHIP Payment Access Commission have suggested Congress extend it further because many children may fall through the cracks even with the coverage expansions in place under the healthcare reform law.

Rockefeller's bill would extend funding out through 2019.

The federal government spent $13 billion in fiscal 2013 on CHIP, which covers children in families earning up to 200% of the federal poverty level. Rockefeller's bill would increase eligibility to up to 300% of the federal poverty level.

The American Academy of Pediatrics, which previously recommended that funding be extended to 2019, has already endorsed the measure.

“Uninsured children are three times more likely than children with insurance to lack access to a needed prescription medicine, and five times more likely to have an unmet need for medical care,” said Dr. James Perrin, AAP president, in a news release. “Hand-in-hand with Medicaid, CHIP has been critical in helping to reduce the number of uninsured children to record lows and ensuring that children have timely access to high-quality, age-appropriate, affordable health insurance.”

Follow Andis Robeznieks on Twitter: @MHARobeznieks