Physician Groups Urge Lawmakers To Preserve Medicaid Primary Care Pay Raise

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More than 200 national and state physician groups have joined in an effort to kill a proposal under discussion in the deficit reduction talks that would cancel a pending increase in Medicaid reimbursements for primary care physicians, a top official with the American College of Physicians (ACP) confirmed Dec. 6.

Bob Doherty, senior vice president for governmental affairs and public policy with the American College of Physicians, told BNA, “We heard from multiple sources on the Hill late last week that this idea was being discussed, although we have seen nothing on paper.”

According to Doherty, House Republicans proposed canceling the primary care physician pay increase--scheduled to begin in January--to help pay for another high priority among physicians: a so-called doc fix. To avoid annual, mandatory cuts in Medicare provider reimbursements, required by the 1997 Deficit Reduction Act, Congress has routinely passed legislation--known as a doc fix--to cancel the cuts.

“This is robbing Peter to pay Paul,” Doherty said. “In this case the 'Peters' are the primary care doctors treating the poorest of the poor in Medicaid.”

Primary Care Increase Due in January.

The increase in primary care physician reimbursements, which was enacted as part of the Affordable Care Act, would reimburse physicians treating Medicaid enrollees at the same rate physicians receive for treating Medicare patients. Medicaid reimbursement rates are lower than Medicare reimbursement rates and often are “well below the actual costs of providing care,” according to ACP.

On Nov. 1, the Centers for Medicare & Medicaid Services issued a final rule (CMA-2370-F) on the primary care increase, which will extend through at least 2014 (20 HCPR 1715, 11/5/12). The pay increase will help to ensure that Medicaid enrollees have access to primary care physicians when a scheduled expansion of Medicaid--also included in ACA--takes place beginning in 2014.

The primary care physician reimbursement increase under Medicaid would begin on Jan. 1, 2013, the same date a mandatory cut of about 30 percent in Medicare provider reimbursement rates is scheduled to occur if there is no doc fix.

Doherty said most members of the physician groups fighting cancellation of the primary care increase typically handle both Medicaid and Medicare patients. “There is a fundamental disconnect in the idea that you cancel one pay increase to avoid another pay cut,” he said.

Congress could include a doc fix as part of any agreement on avoiding the so-called fiscal cliff, a combination of deep spending cuts and tax increases scheduled to take place automatically Jan. 1. In the absence of a deficit reduction agreement by year's end, lawmakers have said they would consider enacting a separate doc fix (see related story).

“It's hard to gauge how serious this proposal is,” Doherty said. “But we took it seriously enough to consult with other physician groups and send a strong signal to Congress that this was a nonstarter.”

On Dec. 5, ACP and other physician groups wrote to Senate and House leaders expressing their “strong opposition” to the proposal to cancel the primary care payment increase.

“Elimination of this policy further burdens the already challenged Medicaid system of today,” said the letter, signed by national and state medical groups, including the American Medical Association, American Pediatric Association, and American Academy of Family Physicians.

By Ralph Lindeman  

The letter from physician groups to Senate and House leaders is at

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