Report: Low physician payments hamper Medicaid expansion

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The low reimbursement rates many states set for providers have hampered the goals of Medicaid expansion, according to a report delivered to the American Medical Association (AMA).

Expanded Medicaid coverage provided by the Accountable Care Act has cut costs and improved revenue for payers in states that have adopted expansion programs, and the Department of Health and Human Services has stated its expectation that expansion would increase access to behavioral healthcare, FierceHealthcare has previously reported.

But while Medicaid expansion programs have improved access to health insurance, that has not necessarily translated into better access to healthcare, the report argues. Low physician payment levels have actually hurt access to care, according to the report, which cites wait times of four weeks or more at 1 in 4 providers.

In addition, the report said, half of all providers either refused to accept new patients enrolled in a Medicaid health plan or opted not to participate in the plan at all.

The report recommends that the AMA push for strict oversight of state physician payment rates by the Centers for Medicare & Medicaid Services (CMS). It also says the AMA must “advocate that CMS develop a mechanism for physicians to challenge payment rates directly to CMS.”

Given the cost to the federal government, Robert Hertzka, M.D., chair of the AMA Council on Medical Service, emphasized the need to ensure better quality of care, according to MedPage Today. “We should be doing it in the most efficient way that benefits our patients the most,” he said.

- here’s the MedPage Today article
- check out the report