From the Chair

Kuchka-Craig Column

Debora Kuchka-Craig, FHFMA

Second-class citizens. That's how Medicaid beneficiaries must feel sometimes when they're looking for a physician. Will that scenario change under healthcare reform?

It's no secret that low Medicaid reimbursement rates have deterred many physicians from participating in Medicaid, often making it difficult for Medicaid beneficiaries to access medical care outside of hospital settings. In the years ahead, with the supply of primary care physicians dwindling and the healthcare needs of aging Baby Boomers growing, access to primary care will be a challenge across the board. So what will happen as 16 million newly eligible people flood the Medicaid rolls, starting in 2014 and beyond? Will the reform law's extension of Medicaid eligibility turn out to be an empty promise?

The good news is that the new law includes provisions to mitigate low Medicaid physician payment rates. Specifically, Medicaid payments for primary care will increase to 100 percent of Medicare rates during 2013 and 2014, with the federal government picking up the tab. (Medicaid primary care payment rates were about two-thirds of Medicare rates on average in 2008, according to a study published by Health Affairs in 2009.) Although it's too soon to tell if this boost will attract enough physicians to handle the increased Medicaid patient volume, we probably can't count on it.

What we can do is look for primary care access solutions that are within our reach, as providers and payers. Solutions that increase productivity, such as group appointments for treatment of patients with chronic conditions such as diabetes and asthma, and expansion in telehealth. Collaborative solutions that make appropriate use of physician assistants and nurse practitioners to provide primary care to all patients-not just those receiving Medicaid. And innovative solutions such as medical homes, which can enable primary care physicians to practice in a professionally rewarding and satisfying setting that is dramatically different from the high-volume, brief-encounter approach that Medicaid payment structures have incentivized in the past.

Our state government partners must step up to the challenge as well. Medicaid agencies have to understand that we're all in this together, working to manage care for the benefit of the patient. When states simply pass their financial woes through to providers or Medicaid managed care organizations, it does not solve the problem-and it most definitely does not benefit the patient. States and Medicaid managed care plans have an obligation to think creatively and work collaboratively on these issues, just as providers do.

Inadequate Medicaid physician payment has been a barrier to access for too many patients, for too long. It's unclear whether legislative and public policy solutions will be enough to solve the problem. But we should not be sitting on the sidelines and waiting to see how the implementation of reform legislation plays out on a national scale. It's time to step up and collaborate with clinicians, physicians, payers, and state agencies to ensure that none of our patients-regardless of insurance source or status-receive anything but first-class medical care.

Publication Date: Friday, October 01, 2010

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