Doctors brace for return of financial pain as 2-year Medicaid raise expires
Thursday, December 18, 2014
Posted by: Samantha Porter
More than half of Ohio's primary care doctors will keep seeing the same number of Medicaid recipients after a significant but temporary pay boost expires at year's end – while 7 percent say they'll stop accepting Medicaid entirely, according to a survey by two physician trade groups.
The Affordable Care Act raised Medicaid payments for two years to equal Medicare for certain primary care services, mainly assessments and vaccinations. On Jan. 1 rates go back to their previous levels – about 59 cents on the dollar compared to what Medicare pays.
An Urban Institute study last week estimated Ohio doctors face a 45 percent pay cut for 27 procedures it examined.
The expiration has caused widespread worry that patients on Medicaid, especially new enrollees under expanded eligibility, would have trouble finding a doctor.
Ohio has 10,000 physicians in family practice, internal medicine and pediatrics who qualified for the pay boost. The bulk of Ohio Medicaid is administered by private managed care plans; starting in mid-2013 the state sent plans quarterly lump payments to pass through to doctors.
Even though doctors knew all along the increase was temporary, Medicaid rates had been flat for several years, so erasing the raise exacerbates a problem building for a long time, said Ann Spicer, executive vice president of the Ohio Academy of Family Physicians.
"I don't think there's any doubt it will be an issue," she told me. "If you're losing money on Medicaid patients, clearly there's only a set number you can afford to take."
But here is an important distinction: About one in 10 Medicaid enrollees in Ohio in 2013 got treatment at clinics in low-income areas that under a federal designation get paid their actual expenses – so neither the pay boost nor the upcoming cuts apply.
The 2014 patient volumes for those clinics are expected to be significantly higher because of the Medicaid expansion in January, said Julie DiRossi-King, chief operating officer of the Ohio Association of Community Health Centers.
As I've reported before, Medicaid expansion has resulted in hiring more doctors and shorter wait times at Lower Lights Christian Health Center in Columbus.
"It has a significant impact on the safety net, including community health centers and our ability to grow," DiRossi-King said.
Outside those clinics, the Family Physicians group and Ohio State Medical Association teamed up on a survey to assess if the pay increase changed business practices for Ohio doctors. It got 560 responses from a mix of urban and rural, employed and independent practices.
Nearly all the respondents historically had accepted Medicaid, and 38 percent said they increased the proportion of Medicaid patients because of the raise. Most made no business changes, but 18 percent said they hired more staff, and one in 10 extended hours. Some used the windfall to invest in electronic records, Spicer said.
About one in three, or 31 percent, responded they will reduce the proportion of Medicaid patients when the pay hike expires, but 52 percent said they would make no change.
"The Medicaid patients they have, they will keep, because they don't want to cut them off," Spicer said. "They won't accept new, because they can't afford to."
Delays in implementing the program – payments didn't start until mid-2013 – kept it from being as effective as it could have been, she said.
Spicer said she heard from doctors daily who were hesitant to add staff or take on more patients because they were worried the law would be repealed or the enhanced pay otherwise blocked.
"They never thought they were going to see this money," she said. "It is very difficult to weigh the value of the increase just because of all the obstacles that happened in conjunction with the rollout."
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