The catch? The bump only applies to internists, family medicine physicians, and pediatricians. The House-passed bill included ObGyns—women’s primary care providers—but the Senate bill did not, and the Senate bill was the version ultimately enacted into law.
To qualify for these additional payments, physicians must self-attest to the state Medicaid agency that she or he meets one of the following criteria:
- board certification in family medicine, general internal medicine, or pediatric medicine or a subspecialty recognized by the American Board of Medical Specialties, the American Board of Physician Specialties, or the American Osteopathic Association
- 60% of Medicaid billing involves the specified E/M and vaccine administration codes.
For newly eligible physicians, the previous month’s billing is used to determine eligibility.
In speaking with ACOG Fellows, here’s what ACOG President John Jennings, MD, had to say about the omission of ObGyns from the primary care rate bump:
We have before us a very small but important window. Right now, family physicians, internists, and pediatricians get paid 100% of Medicare rates for Medicaid E/M, while we get paid 60% on average.
This federal program, which expires at the end of this year, was designed to increase access to needed primary care services for low-income individuals. But as the program stands right now, it leaves out women’s health.
That’s just not right. And we have before us a chance to fix it.
ObGyns deliver primary and preventive care services to women; an ObGyn often is the only doctor a woman sees on a regular basis. Thirty-five state Medicaid programs classify ObGyns as primary care providers.9 Twelve percent of women aged 18 to 64 years rely on Medicaid for their health coverage, and more than 68% of adult Medicaid beneficiaries are women.10
Seeing an opportunity to expand the primary care reimbursement bump to include ObGyns, ACOG recently briefed Congress on the long and deep tradition of primary care in obstetrics and gynecology—a tradition that begins in residency. We provided Congress with ObGyn resident training requirements, as outlined by the Council on Resident Education in Obstetrics and Gynecology (CREOG).11
According to CREOG, “ObGyns provide primary health-care services to their patients both within and outside the traditional purview of reproductive medicine. As primary care physicians, ObGyns establish relationships with their patients that transcend the disease spectrum and extend to routine assessments, preventive care, early intervention, and management of medical disorders.”11
Among the services they provide are age-appropriate screening for substance use, sexual and reproductive health, sexually transmitted infection, psychosocial risks, breast disorders, cancer, and cardiovascular disease. ObGyns routinely counsel patients about diet, exercise, contraception, dental health, osteoporosis, and sexual health. And they provide front-line immunizations against such diseases as influenza, human papillomavirus, rubella, measles, meningitis, hepatitis A and B, and pneumonia.11
Certification in obstetrics and gynecology requires written and oral examinations in office practice and women’s health as a primary care content area. In fact, fully one-third of the board certification test taken by 97% of the ObGyns in this country tests their knowledge and training in primary care.11
A 2014 survey of women found that ObGyns play a critical role in providing primary care in the United States. Almost six in 10 women (58%) report that they see an ObGyn on a regular basis, and one-third of women (35%) view their ObGyn as their main source of care.12
Low-income women and women of color report that their ObGyn plays an even greater role in their health care. Latinas are far more likely (47%) to report that their ObGyn is their main source of care, compared with 35% of women overall. Sixty-four percent of African-American women say they see an ObGyn regularly, compared with 58% of women overall.12
Other survey findings:
- ObGyn providers are the first providers women choose as adults. They move from a pediatrician to an ObGyn.
- ObGyn providers are the “usual” providers for young women—the ones women see most frequently. They see internal medicine physicians and other providers infrequently during this period of their life.
- The ObGyn-patient relationship is intimate, comfortable, trusting, and confidential, and ObGyns often are considered “a friend.” Patients discuss issues with their ObGyns that are not raised with other providers.
- The care women receive from their -ObGyn provider is broad, ranging from an annual exam and breast exam to prenatal care, immunizations, a review of medications, blood pressure checks, and more.
- Women say their ObGyn does a better job than their family practice and internal medicine providers in providing a range of care and services.12
