Government Watch

Obamacare Watchdog: Questions Linger About Implementing Doctors’ Medicaid Pay Raise

Provided by Kaiser Health News – by Phil Galewitz – Oct 23, 2012 –

To recruit more doctors to treat the poor, President Barack Obama’s health law took a simple approach: temporarily pay doctors more money.

Starting Jan. 1, primary care doctors when treating patients on Medicaid, the state-federal health insurance program for the poor, will get the same rates they are paid when caring for seniors in the Medicare program. The higher rates will last for two years.

While Medicaid fees vary by state, they are generally far below Medicare and private plans. The change, which will cost $11 billion and will be paid by the federal government, means a 64 percent average pay increase, according to an Urban Institute analysis of the rates in 2010.

But implementing the raise is not so simple.

“The higher rate sounds great and was used by the Obama administration to sell the law, but the devil is in the details and we don’t yet have the details to go out and recruit doctors,” said J. Mario Molina, CEO of Molina Healthcare, one of the nation’s largest Medicaid managed care health plans with 1.8 million members.

With two months to go, doctors, state officials, and Medicaid managed care plans say there are numerous details still to be worked out.

The Obama administration has yet to issue final rules for the pay hike and most industry officials don’t expect one until after Election Day. In addition, some states have been hesitant to promote the provision because Republican presidential nominee Mitt Romney has vowed to repeal the health law if he is elected.

Medicaid Pay Varies Widely
How much each state pays doctors for Medicaid primary care services compared to Medicare rates.
State Pct. of Medicare Rates
AL 70%
AK 125%
AZ 86%
AR 69%
CA 43%
CO 77%
CT 72%
DE 98%
DC 94%
FL 50%
GA 70%
HI 59%
ID 91%
IL 53%
IN 55%
IA 76%
KS 82%
KY 72%
LA 76%
ME 64%
MD 74%
MA 70%
MI 51%
MN 47%
MS 90%
MO 57%
MT 102%
NE 76%
NV 71%
NH 62%
NJ 50%
NM 85%
NY 51%
NC 86%
ND 141%
OH 60%
OK 95%
OR 74%
PA 56%
RI 33%
SC 79%
SD 76%
TX 62%
UT 66%
VT 83%
VA 75%
WA 72%
WV 71%
WI 61%
WY 104%
US Avg. 61%
Source: The Urban Institute, 2010 figures.

Among the unfinished operational details cited:

–It’s not completely clear which doctors can get the higher pay. Traditional primary care doctors, such as family physicians, internists and pediatricians, are assumed to be covered. But some specialists, such as pediatric cardiologists, also could be eligible if they provide a certain amount of primary care, according to a preliminary regulation released by the Department of Health and Human Services in May. There is also come confusion about what services are covered under the pay raise. The regulation said the raise will apply to “evaluation and management” of patients, not procedures or performing diagnostic tests.

–Medicaid managed care plans, which today enroll about half of the 60 million Medicaid recipients, are unsure how the additional compensation will be passed onto them and how they will compensate doctors paid a flat or capitated monthly fee.

–The federal government hasn’t published its Medicare rates for 2013 so states say they can’t tell doctors what the increases will be for Medicaid.

–Doctors are worried there is no deadline on when states have to reimburse them at the higher rates.

The confusion could undermine the goal of attracting more doctors to treat patients on Medicaid, which under the health law could gain as many as 17 million new enrollees starting in 2014, some experts say.

“This has tremendous implications for increasing access to primary care, especially in states like Florida and California, where Medicaid rates are very low, but only if it can be implemented properly and relatively soon,” Molina said.

The questions mean states have yet to start promoting the pay raise to doctors.

“It’s a difficult political environment to tout a provision like this in the Affordable Care Act as a recruiting tool,” said Andy Allison, Arkansas Medicaid director and chairman of the National Association of Medicaid Directors.

In a statement, the Centers for Medicare and Medicaid Services said: “Studies show that when states pay physicians higher rates under their Medicaid programs, more physicians participate.”

A report last year by the non-partisan Center for Studying Health System Change said the temporary nature of the pay raise could limit its effectiveness.

Rebecca O’Hara, a vice president of the Florida Medical Association, said doctors may be dismayed by the two-year limit. In Florida, she estimated the fee increase means a doctor would get paid $65 for a basic office visit rather than $32, but she added doctors fear having the higher fees revert back in 2015.

“Will we see physicians running to sign up for Medicaid because of potential for making money? I would say that’s unlikely,” she said.

Robert Hughes, president of the Medical Society of the State of New York, said most doctors won’t change their practices for a temporary rate hike and, as a result, Medicaid recipients will continue to rely on public health agencies and community health centers for care.

Ideally, states would have liked more time to implement the pay raise to widen its impact, said Tricia McGinnis, a director for the Center for Health Care Strategies, a nonprofit group consulting with several states on the issue. “Implementing something in two months will be tricky,” she said

A senior Obama administration official, who would only speak on condition of anonymity, downplayed the concerns and said the pay raise would take effect on time in January.

The official said most primary care doctors are aware of the pay raise and states and managed care firms can easily access current Medicare rates.

The controversy about the new payments has produced one interesting twist. A key motive for improving access to primary care doctors was to reduce Medicaid patients’ unnecessary use of expensive emergency rooms.

But emergency room doctors say they should qualify for the higher pay rates because many of their doctors provide primary care services, according to a letter from Dr. David Seaberg, president of the American College of Emergency Physicians, to CMS acting Administrator Marilyn Tavenner. “It has been the longstanding policy of CMS to provide for payment by the service-not by type of physician performing the service,” Seaberg stated.

 

 

 

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13 Comments on "Obamacare Watchdog: Questions Linger About Implementing Doctors’ Medicaid Pay Raise"

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Phil
3 years 10 months ago

The scarest words in the english language: “Hi! I’m from the Federal Government and I am here to help you.”

Alvin Bivings
3 years 11 months ago

You forgot to mention that for some of us seniors who paid $0 premiums for advantage plans, on Jan. 1, we will have to pay$128. for my wife and myself($64. each). This amounts to and additional burden of over $1500. yr from our $22,000. income. I think we are paying for medicaid also!
Doreen and Alvin

J.R. Wheeler, Jr.
3 years 11 months ago

Obama’s best security is Biden….Nobody wants him to become President!

PaulE
3 years 11 months ago

Nobody wants Obama as President either.

DrJCA1
3 years 11 months ago

Towards the end of my 40 year career in medicine, I decided to stop taking any new patients where my income was determined by some fool in Washington. No business can stay afloat when their income fluctuates depending on who is in office at that time. When we bill for a physical exam that takes 45 minutes to an hour, we need to get paid for that hour, not some absurd amount based on government dancing numbers. My overall costs to keep up with all the rules, regulations, and laws pertaining to my practice was about 30% of income. Then they decided to dump 30 million more people into this system (already overcrowded with patients) and tell us what they will pay. Retirement feels great.

PaulE
3 years 11 months ago

I have a feeling you’re going to have lots of company as more and more doctors opt to follow your lead and retire.

Shastastan
3 years 11 months ago

If I were a doctor, I’d probably do the same thing. One of my wife’s doctors has never taken any insurance period. He does bill Medicare for his patients, but all pay up front. If all the docs would have done this, I believe that we would all be better off today. The insurance companies are running the healthcare industry. I’ve had one doc retire and have lost 2 others who became in-hospital docs. We are trying to get all of our known medical and health needs done before the end of the year because we realize that healthcare will be very scarce with the arrival of Obamacare. I’m 73 and don’t know what my care in the future will be.

JOHN
3 years 11 months ago

WHY IS IT NO ONE HAS REALLY LOOKED INTO THE OBAMA ,HEALTH PLAN IS IT HE NEEDS SELF SATISFACTION ON TRYING TO TELL THE GENERAL PUBLIC HE HAS NO EXPERTISE IN ANY FIELD , SO THE TAKERS WILL VOTE FOR THE HAND OUTS.

PaulE
3 years 11 months ago

I see posting on the AMAC site is still hit or miss.

3 years 11 months ago

Kindly email the comment you were trying to post to psmith@amac.us. I will try to post it myself to see if I can determine why it failed.

TONY SIKES
3 years 11 months ago

I RECENTLY DROPED MY MEMBERSHIP IN AARP, (BECAUSE THE LEADERSHIP SUPPORTED OBAMACARE, CONTRARY TO THE WISHES OF THEIR MEMBERSHIP) AND JOINED YOUR GROUP. I WILL CONTINUE TOBE AN ACTIVE MEMBER AS LONG AS YOU SUPPORT YOOUR MEMBERS WISHES..
CONTINUE YOUR GOOD WORKS. KEEP US INFORMED.

Don Cunningham
3 years 11 months ago

If I were a doctor why would I trust this administration if The federal government hasn’t published its Medicare rates for 2013. This administration is nor trustworthy.

Robert Macik
3 years 11 months ago

When did DC become a state and Tennessee become an orphan? As far as I know we never seceded.

Other than that–good article.

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