Feds Set to Boost Primary Care Medicaid Payments for 2 Years


The federal government is giving primary care physicians who treat Medicaid patients a pay raise in 2013 and 2014.

Starting on Jan. 1, the Medicaid program will pay Medicare rates for providing certain primary care services to its beneficiaries. The temporary payment boost is mandated under the Affordable Care Act and will run through the end of 2014. Officials at the Centers for Medicare and Medicaid Services outlined the specifics of the move to parity with Medicare payments in a proposed rule released May 9.

Dr. Roland Goertz

For many, this will mean a significant increase in Medicaid payments, according to Dr. Roland A. Goertz, board chair of the American Academy of Family Physicians. Data from 2008 shows that Medicaid rates are on average only 66% of Medicare rates for primary care services.

Dr. Goertz, who spoke at a press conference announcing the proposed rule, said that while the increased payments are good news, he is concerned about what happens at the end of 2014 when they are rolled back.

Right now, about two-thirds of his organization’s members accept Medicaid patients despite the lower payment from the program. But that’s not the basis for good public policy, he said.

"We can’t continue depending on the goodwill of physicians who provide care for less than the cost of that care," said Dr. Goertz of Waco, Tex.

Under the proposed rule, the higher payments will apply only to primary care services provided by family physicians, general internists, and pediatricians.

Higher rates will also be available for primary care services provided by related subspecialists. Any subspecialties within family medicine, general internal medicine, and pediatric medicine that are recognized by the American Board of Medical Specialties will be eligible, according to the proposed rule. A rheumatologist or a pediatric cardiologist, for instance, would qualify for the increased payment if he or she delivered certain primary care services.

Some nonphysician providers also will be eligible for increased payments. For instance, nurse practitioners who provide primary care services would be able to receive the higher payment if they work under the supervision of a qualifying physician and bill under that physician’s Medicaid provider number.

The payment policy applies to Medicaid fee-for-service patients and those enrolled in managed care plans, according to CMS.

The federal government will cover the full cost of the increase in provider payments, at an estimated cost of $11 billion over 2 years. That estimate does not take into account the potential savings to the Medicaid program from beneficiaries having increased access to preventive care, CMS officials said.

Recommended Reading

Why 30-Day Readmissions Are High
MDedge Cardiology
HHS Calls for 1-Year Delay for ICD-10
MDedge Cardiology
First Medicare ACOs Sign the Dotted Line
MDedge Cardiology
FDA Addresses Antibiotic Use in Food-Producing Animals
MDedge Cardiology
Implementing Health Reform: Physician Compare
MDedge Cardiology
Medicare Hospital Fund Insolvent by 2024
MDedge Cardiology
ACP, Consumer Reports Collaborate on Treatment Guidelines for Consumers
MDedge Cardiology
Problematic Physician Behavior Can Be Cured
MDedge Cardiology
Empowerment's Price Tag: Shared Decision-Making May Be Costly
MDedge Cardiology
IOM Urges Collective Action Against Obesity
MDedge Cardiology