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New Year, New Medicaid Reimbursement Rates

Primary care physicians and practitioners who treat Medicaid patients will receive higher reimbursement rates in 2013.

For the next two years, primary care providers will get the same payments for treating Medicaid patients as they would for Medicare patients. The payments for Medicare patients have traditionally been higher.

The increase will be paid for by the federal government as part of an Affordable Care Act initiative to boost access to primary care and preventive medicine.

“By improving payments for primary care services, we are helping Medicaid patients get the care they need to stay healthy and treat small health problems before they become big ones,” said Health and Human Services Secretary Kathleen Sebelius speaking about the increase in a statement last year.

C. Richard Schott, a cardiologist in Southeastern Pennsylvania and the President of The Pennsylvania Medical Society says the lower Medicaid payments doctors received until this year may not cover the cost of providing care.

“In many of these cases, you’re actually paying money in the overhead for seeing these patients,” he said.  Schott added that expenses often exceed reimbursements.  

Schott calls the underpayment for Medicaid services a serious issue.

“Medicaid payments for many of these evaluation and management services for vaccines and many of these new comprehensive exams – many of these services are paid at 50 percent of Medicare,” said Schott.

Medicare historically has paid at a lower level than commercial health insurance and Medicaid, the medical insurance plan for the poor and disabled, has paid at an even lower rate.

“Many of these young physicians are coming out with enormous medical school and college debt and they look at the reimbursement issue and it tends to be a factor in dissuading people from going into primary care,” he said. 

According to an analysis from 2010, the change will provide an average 64 percent reimbursement increase.

A study released last year from the National Center for Health Statistics and published in Policy journal “Health Affairs,” found more than 30 percent of doctors did not accept new patients who are Medicaid beneficiaries because the payment rates were too low.

Schott says primary care has traditionally been reimbursed at a lower rate compared to other medical specialties, particularly for Medicaid patients.

“They are oftentimes difficult patients to care for and I think [providers] see this as a real plus in terms of leveling the playing field for Medicaid patients to be able to provide them access to care,” he said.

The pay hike affects pediatricians, primary care physicians and internists.

Obstetricians and gynecologists, along with emergency room doctors are excluded from the pay increase. Schott said that is a problem.

“A lot of women see only their OB/GYN-type physicians and they rely on them for primary care although most of them do not receive total comprehensive primary care from an OB/GYN,” he said.

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