Medicaid paying docs way more for primary care, but tactic may not work

Despite an increase in payments to primary care doctors in order to widen participation in the nation's vastly expanded Medicaid program, many are not grabbing the bait, causing concerns of a physician shortage, the New York Times reported.

Altogether, industry experts expect an estimated 9 million Americans to join the Medicaid program nationwide in 2014, as about half the states accept federal funding to expand eligibility to either 133 percent or 138 percent of the federal poverty level.

Under the Affordable Care Act, primary care physicians will see a 73 percent bump in payments for treating Medicaid patients, which will bring the rate in parity with Medicare, according to the NYT article. However, the increase is only set to last through 2015.

But many physicians say their practices are already bursting with Medicaid patients, such as Hector Flores, M.D., who practices in East Los Angeles and also chairs the family medicine department for the area's leading hospital, White Memorial Medical Center. Flores treats a mind-boggling 26,000 patients in his practice already, about eight times the typical family practice with commercially insured patients. California expects to add about 2 million residents to its Medicaid rolls in the next couple of years, according to the NYT. However, 57 percent of its primary care physicians already refuse to accept Medicaid patients.

Studies indicate the Medicaid patients already have more barriers to primary care access than those patients with commercial coverage, making them more likely to seek care in hospital emergency rooms, FierceHealthcare previously reported.

Access to specialists can also be particularly difficult. "I can tell you it's very, very hard to get them in to see those specialists," Paul Urrea, M.D., a Los Angeles-area ophthalmologist, told the NYT. He noted that even patients with conditions threatening their eyesight can wait months before seeing a doctor.

Forbes magazine suggested in a recent opinion piece that physicians may be forced to see Medicaid patients as a precondition for keeping their licenses in states supportive of the ACA, although there is no concrete evidence that such a scenario would happen

To learn more:
- read the NYT article
- check out the Forbes article

Related Articles:
Medicaid patients with PCP barriers flock to ED--more coming soon
Fewer specialists willing to treat Medicaid patients, raising questions for expansion
HHS proposes pay raise for Medicaid primary care
Why poorer patients prefer hospital care
'Frequent flyer' ER visits drop with coordinated care
Medicaid expansion, patient influx may result in doctor shortage

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