Reform Update: Increase in Medicaid reimbursement could disappear Dec. 31

The Patient Protection and Affordable Care Act's provision to temporarily increase Medicaid reimbursement for primary-care services to match Medicare rates has led to a big increase in Ohio physicians accepting new Medicaid patients. But that increase may go away when the ACA primary-care parity provision expires Dec. 31.

Before the parity provision kicked in, Ohio was reimbursing primary-care doctors at 59% of the Medicare rate. The Ohio State Medical Association reported that 2.7 million state residents are covered by Medicaid, and this includes almost 339,000 who became eligible when Ohio expanded its program to include individuals with incomes up to 138% of the poverty level.

Most of the physicians who responded to the OSMA online survey (90%) said they were already seeing Medicaid patients before the pay increase. Nearly 40% of them, though, said they had started seeing more. And nearly as many said they would discontinue seeing Medicaid patients it the parity provision is not extended.

Six states have acted to extend the parity provision for one year: Alabama, Colorado, Iowa, Maryland, Mississippi and New Mexico.

Legislation has been introduced in Congress that would extend the pay increase: A Senate bill introduced by Sens. Sherrod Brown (D-Ohio) and Patty Murray would extend the pay raise for two years; a House of Representatives bill (PDF) sponsored by Rep. John Lewis (D-Ga.) would extend it for five years.

“There are all types of social dynamics being played out,” said Matt Salo, executive director of the National Association of Medicaid Directors, who predicted up to a dozen states may ultimately decide to fund the pay increase if Congress doesn't act.

Many states are waiting to see if Congress does anything, and Congress may be less likely to do anything if more states act on their own, Salo said.

“If I were a betting man, I'd say it's 50-50 that Congress will act—most likely after Jan. 1,” he said. If the pay increase is extended next year it would most likely be made retroactive to the first of the year, he added.

According to the Ohio medical association, there were 10,023 Ohio physicians who received the increased Medicaid reimbursement for primary care. The organization was able to identify an e-mail address for 7,241 of them and invited these doctors to participate in an online survey (PDF) and 559 responded.

“This current rate increase is only temporary and yet has proved invaluable for introducing more patients to high quality healthcare, so just imagine how impactful extending this rate increase could be for improving the long-term overall care of Ohioans and bettering the health of our communities,” Dr. Mary Wall, OSMA president, said in a news release (PDF). “If we go back to reimbursing primary-care physicians at 59 cents on the Medicare dollar, doctors may lose money each time they see patients and thus be forced again to turn away patients who have Medicaid.”

If the Medicaid primary-care parity provision was made permanent, 60% of the Ohio doctors responding to the survey said they would make some Medicaid-related business decisions. Sixty percent said they would see more Medicaid patients, about a third said they'd add staff, and nearly 13% said they'd increase their hours.

A majority of physician leaders responding to an American College of Physician Executives’ one-question survey said they believe the healthcare industry’s transparency movement will strengthen the doctor-patient relationship.

The transparency movement includes publicly posting the prices for healthcare services and Medicare payments made to doctors, publicizing fraud and abuse claims, and releasing how much money drug and medical device makers pay physicians.

The survey was available to the ACPE’s 11,000 members and 631 responded, with 52% saying that increased transparency will improve doctor-patient relations, 24% saying it won’t have any effect, and 22% saying it will damage or weaken relations.

Participants were invited to submit comments on the question, with one stating transparency was “completely unnecessary and things will be misconstrued.”

“If doctors are CARING for patients, transparency will not harm the doctor-patient relationship,” another ACPE member wrote. “If doctors are GAMING the system, then transparency may hurt them. Until the public has a better understanding of the data it will just be confusing to everyone.”

Many expressed support for transparency, but worried about how information is reported.

“I agree in principle but the data is not very accurate, easy to game, and in many cases irrelevant,” one respondent said. “Transparency at this point in time may do more harm than good.”

Another, however, expressed no doubts whatsoever.

“My office has had a transparency policy and the patients are appreciative,” the ACPE member said. “The need for transparency is tied to trust and communication all vital to success in an era of p4p (pay for performance) and shared risk. But the door must swing both ways so that the administrators at institutions, the physicians that are aligned with them, the payers, and regulators/accrediting bodies act together to provide quality services. Health can then become the center of healthcare!”

Follow Andis Robeznieks on Twitter: @MHARobeznieks