Increased Medicaid reimbursement for primary-care services to match Medicare rates led to an increased appointments for Medicaid patients, a new study finds.
But those care access gains could be wiped out this year because the Patient Protection and Affordable Care Act's provision authorizing the bump expired Dec. 31, 2014, according to a study published Jan. 21 in the New England Journal of Medicine.
“Our findings suggest that providing higher Medicaid payments is an effective strategy for ensuring access to enrollees among already participating primary care providers,” the study authors wrote.
The availability of primary-care appointments for Medicaid beneficiaries in surveyed areas grew from 58.7% to 66.4% when comparing the two time periods studied: November 2012 through March 2013; and May 2014 through July 2014.
Increased appointment availability was comparable in states that expanded Medicaid coverage and those that did not. That finding was potentially significant because there wasn't evidence of a strain on provider capacity in states that expanded the federal program, the study authors wrote.
Providers aggressively lobbied Congress to extend the pay bump, but were hindered in part because they didn't have statistically valid data to prove its benefit, said Dr. Robert Wergin, president of the American Academy of Family Physicians.
With such data now available, lawmakers may reconsider their decision, said Daniel Polsky, the study's lead author and executive director of the Leonard Davis Institute of Health Economics at the University of Pennsylvania.
“I could see the reluctance to maintain the Medicaid pay bump without clear evidence that it was working,” Polsky said. “But now we have the evidence. Hopefully, this will influence the priority given to adequate reimbursement for primary care in Medicaid.”
“Meaningful steps to address low Medicaid payment rates would acknowledge the value of primary-care services and the importance of adequate payment to improve access to care,” said Dr. Robert Wah, president of the American Medical Association.
The average national Medicaid reimbursement to primary-care physicians will drop between 43% and 47% with the end of the pay bump provision, research has shown.
“Opting not to extend the enhanced payments may significantly decrease the availability of primary care appointments for Medicaid enrollees, particularly in states that had low Medicaid reimbursements before the increase,” the study authors said.
To get a sense of the impact of paying primary-care doctors more to see Medicaid beneficiaries, study researchers pretended to be new patients seeking an appointment and cold-called providers in 10 states: Arkansas, Georgia, Illinois, Iowa, Massachusetts, Montana, New Jersey, Oregon, Pennsylvania and Texas.
Last fall, the Kaiser Family Foundation reported that 22 states indicated they would not be continuing the primary-care rate increase, with another 14 states indicating they were still evaluating whether the enhanced rates had any impact on provider participation.
Another 15 states: Alabama, Alaska, Colorado, Connecticut, Delaware, Hawaii, Iowa, Maine, Maryland, Michigan, Mississippi, Nebraska, Nevada, New Mexico and South Carolina all indicated they will continue paying the higher rates at least partially if not fully.
In states that don't maintain the bump, some providers have committed to continuing to see patients added to their rosters when the raise was in effect, Wergin said. However, providers were less willing to commit to adding new Medicaid beneficiaries going forward.
“With those kinds of cuts, they say they'll look very hard at adding new Medicaid patients,” Wergin said.
Follow Virgil Dickson on Twitter: @MHvdickson