It’s a pretty safe bet that you’d be happy if someone agreed to pay you more to do the same thing you’ve already been doing.
So, surely primary care doctors can appreciate one provision of the federal health reform law that bumps Medicaid rates for primary care up to the same level as Medicare rates, right? After all, Medicaid rates are famously low, equating to about 66 cents on the dollar when compared to Medicare primary care rates.
But when it comes to physicians’ complicated and often troubled relationship with Obamacare, nothing’s ever simple, and it’s unclear whether the boost to Medicaid primary care payments will have its desired effect.
The hope behind the payment bump is that it’ll persuade more primary care doctors to begin caring for Medicaid patients, and eventually cut costs by keeping those same patients out of emergency rooms. Plus, Obamacare will increase insurance coverage to about 32 million Americans, with about half getting coverage through Medicaid, so the payment bump could head off an access problem as an increasing number of Medicaid patients seek primary care.
But will it actually work? That remains to be seen.
The primary care increase “won’t necessarily affect physicians’ decisions” on whether to see more — or any — Medicaid patients, said Jason Koma, spokesman for the Ohio State Medical Association, the largest doctors’ group in the state.
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“Medicare rates in many cases are already pretty low, so just bumping Medicaid rates up to that level doesn’t necessarily mean that you’re covering the cost of providing care,” Koma said.
Then there’s the “hassle factor” that doctors perceive to be associated with Medicaid, according to Dr. Mike Sevilla, a family physician in the Youngstown, Ohio area.
Sevilla said his practice stopped accepting Medicaid patients several years ago due to bureaucratic issues in addition to low payments.
“In Medicaid contracts in Ohio, there is a lot of bureaucracy involved, meaning that Medicaid determines which test it will pay for, which specialists the patient sees and which meds it will pay for,” Sevilla said. “This is similar to private insurance, but Medicaid plans are more restrictive. Many docs do not take Medicaid because they don’t feel they have the autonomy to make medical decisions for patient care because of the bureaucracy.”
Even with the payment bump, Sevilla still isn’t sure that accepting Medicaid patients will make sense for his practice.
“The question for many practices, including ours, is if the payment increase will overcome the hassles,” he said. “Each physician has to ask that question. Our practice is considering returning to Medicaid, but we still have a lot of questions that need answered from a federal and state level.”
Then there’s another layer of complication that’s holding primary doctors back from fully embracing Obamacare’s increased Medicaid rates. The payment bump is in effect only in 2013 and 2014, which leaves some doctors concerned that the temporary nature of the increase will lead to a second “doc fix” situation.
The “doc fix” refers to one of the most continually vexing federal problems for physicians: Congress has repeatedly implemented short-term measures and never come up with a long-term solution to scheduled cuts to Medicare payments through what’s known as the “sustainable growth rate.” (For more on the doc fix, check out this helpful FAQ from Kaiser Health News.)
The federal government estimates that it will spend $11 billion on increased primary care Medicaid payments for 2013 and 2014, but no additional federal funds are appropriated beyond that, according to The Washington Post.
So physicians are concerned that, if they start seeing more Medicaid patients for increased payments during the next two years, those payments will go right back down again in 2015 and create cost pressure on their budgets. That uncertainty could lead many primary care physicians to conclude that, despite the payment bump, a larger base of Medicaid patients will create more problems for them than it solves.
“We’ve seen this movie before,” Sevilla said.
