NEJM study shows primary care rate increase for Medicaid patients increased access to care

February 02, 2015

A study published in the New England Journal of Medicine last week shows that the increase in Medicaid reimbursement for primary care providers, a key provision of the Affordable Care Act (ACA), resulted in a 7.7 percent increase in new patient appointment availability without longer wait times.

The study, conducted by the University of Pennsylvania and the Urban Institute, used “secret shoppers” to call primary care doctors offices seeking new appointments in 10 states: Arkansas, Georgia, Illinois, Iowa, Massachusetts, Montana, New Jersey, Oregon, Pennsylvania and Texas. Calls were made in two time periods, from November 2012 through March 2013 and May 2014 through July 2014.

While the study did not examine California specifically, it did find that “states with the largest increases in availability tended to be those with the largest increases in reimbursements.” In California, the primary care rate increase more than doubled the rate these providers would have gotten without this key provision in the ACA.

The study provides the first research-based evaluation of the association between the ACA’s two-year Medicaid fee increase — for which federal funding expired on December 31, 2014 — and access to care for Medicaid patients seeking new patient primary care appointments at physician offices.

For Medicaid patients, the average appointment availability increased 7.7 percentage points, from 58.7 percent to 66.4 percent, between the two time periods. There was no change in wait times for appointments.

Low Medicaid reimbursement rates across the country are becoming a hot topic as more and more consumers gain access to care under the ACA. Several court cases that force the issue of access to care for Medicaid patients have shown up in court. Last month a federal court judge ruled that the low Medicaid reimbursement rates in Florida deprived children of necessary care. Last week, the U.S. Supreme Court heard a case originally filed by providers in Idaho who were frustrated with their state’s Medicaid reimbursement rates. The high court is expected to rule on the case by the end of June.

The Urban Institute estimated that provider rates are set to fall an average of 42.8 percent because Congress chose not renew the rate increase. A Kaiser Family Foundation survey found that 15 states will continue some sort of rate increase with state funds. Twenty-four states will return to payment levels before 2013; and it is unknown what the remaining 12 will do to provide access to care.

In California, physicians are faced not only with the expiring ACA pay bump, but also a 10 percent provider reimbursement cut authorized by AB 97 in 2011. California’s abysmally low provider reimbursement rates, which have not been adjusted for increasing costs in two decades make it very difficult for physicians to accept new Medi-Cal patients—placing roadblocks for patient access to care.

Even before the AB 97 cuts, California's Medi-Cal provider payment rates were some of the lowest in the nation. Low reimbursement rates have made it difficult for physicians to continue accepting new patient in the program. As a result, 56 percent of Medi-Cal patients report difficulty finding a doctor.

California's Medi-Cal rates often do not even come close to the cost of providing care. Medi-Cal physicians are currently paid roughly $16 for a regular, primary care visit. For many practices, this is simply unsustainable.

The California Medical Association (CMA) continues to fight with the “We Care for California” coalition for increased Medi-Cal reimbursements. The unprecedented coalition includes the largest statewide organizations representing physicians, dentists, hospitals and health care workers, as well as health plans, first responders, caregivers and other health providers.

“With over 12 million people to be enrolled in Medi-Cal, it is more important than ever to ensure that the program is adequately equipped to handle new patients,” says CMA President Luther F. Cobb, M.D. “California pays some of the nation’s lowest Medicaid reimbursement rates and in order to properly serve the poorest and most vulnerable patients among us, at a minimum, a restoration of the provider cut made in 2011 needs to be restored.”


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