Lawmakers took the first step toward extending higher Medicaid payments to primary care physicians by introducing a bill that would keep the pay bump in place through 2016.
On July 30, Sen. Patty Murray (D-Wash.) and Sen. Sherrod Brown (D-Ohio) introduced the Ensuring Access to Primary Care for Women & Children Act, which would provide a 2-year extension to a provision in the Affordable Care Act that raised Medicaid payments for certain primary care services up to Medicare levels.
Dr. Jeffrey Cain
The Medicaid pay parity provision is currently set to expire on Dec. 31, 2014.
The bill has already garnered the support of the American Academy of Family Physicians, the American College of Physicians, the American Academy of Pediatrics, the American Congress of Obstetricians and Gynecologists, and the American Osteopathic Association.
Without the extension, primary care physicians are essentially facing a steep payment cut for seeing Medicaid patients, said Dr. Jeffrey Cain, AAFP board chair. Medicaid payments vary by state but can be as much as 40% lower than Medicare rates, he said, meaning that physicians who treat Medicaid patients often lose money on every visit.
Dr. Cain said he’s heard from family physicians that they will be less likely to participate in Medicaid if the pay parity does not continue. Similarly, the American College of Physicians estimates that almost half of its members who are participating in the pay parity program would have to reduce the number of Medicaid patients they see or drop out of the program altogether if the funding bump expires at the end of the year.
Under the new legislation, physicians in the specialties of family medicines, pediatrics, and internal medicine, as well as internal medicine and pediatric subspecialties, would continue to receive Medicare-level payments when they provide primary care and immunization services to Medicaid patients through 2016.
The bill also would expand eligibility for the payment increase for obstetricians and gynecologists, nurse midwives, nurse practitioners, and physician assistants.
Getting lawmakers to approve the funding extension by the end of the year could be an uphill battle, but physician groups argue that investing in improved access to primary care will decrease the need for more expensive care, such as visits to the emergency department.
Dr. Cain urged physicians to use Congress’s August recess as a chance to make the case to lawmakers while they are in their home districts.
"We would encourage family doctors to go to the town halls, to meet with [congressional] staffers right now while they are in recess to tell them that this is an important part of practice," Dr. Cain said.
In the meantime, some states are taking action on their own to extend pay parity under Medicaid.
Six states (Alabama, Colorado, Iowa, Maryland, Mississippi, and New Mexico) are spending their own money to extend the Medicaid pay parity through 2015, according to the AAFP. Connecticut is extending the pay bump through the end of June 2015 and Michigan will support Medicaid payments at 78% of Medicare rates.
mschneider@frontlinemedcom.com
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