Affordable Care Act: Meager Pay Raise to Doctors

Starting January 1, 2013, Medicaid must increase the amount paid to primary physicians in North Carolina.  According to Section 1202 of the Affordable Care Act (ACA) – which amends section 1902(a)(13) of the Social Security Act – Medicaid is federally required to pay at the Medicare rate for certain primary care services and to reimburse 100% Medicare Cost Share for services paid in calendar years 2013 and 2014. The codes included in this provision include evaluation and management (E&M) services and immunization administration for vaccines and toxoids.

That’s good, right? Yay! More money for physicians who will take Medicaid patients! That means that more physicians will accept Medicaid, right? WRONG!!!

Concurrently, Obama is slashing the budget for MediCARE by $716 billion. How is he slashing $716 billion of the federal Medicare budget? Largely by reducing the amount Medicare pays to physicians. Let me repeat: While Obama is increasing Medicaid payments to doctors “up to 100% of Medicare payments,” Obama is REDUCING the amount Medicare pays out. This equals a sham. The law states that Medicaid reimbursements will be increased to the amount Medicare  pays out, but Medicare pay out are being slashed.

Medicare already pays a very low amount.  For example, Dr. Joseph Shanahan is a rheumatologist in Raleigh, North Carolina. Shanahan told his local ABC affiliate, WTVD, that he was one of the few rheumatologists left in the Research Triangle area who accepted Medicare patients. “The reimbursement is so low [with Medicare]—in some cases 60, 80 dollars—it costs you more to get a plumber to come to your house than to get a rheumatologist to come to the hospital,” he said. Starting this spring, Dr. Shanahan will no longer accept Medicare patients.

Steve Daniels, a reporter with WTVD, led an investigation into problems with Medicare access in North Carolina. A team of volunteers used the “mystery shopper” method, posing as Medicare beneficiaries looking for a new doctor. Of the 200 family physicians they called, nearly half said that they were no longer accepting new Medicare patients.

What does this tell you about Medicaid? The so-called increases in pay to physicians accepting Medicaid is a sham. The increase, if any, will be meager. Physicians accepting Medicaid will still be scarce.


About kemanuel

Medicare and Medicaid Regulatory Compliance Litigator

Posted on November 28, 2012, in Affordable Care Act, Medicaid, Medicaid Funds, Medicaid Reimbursement, North Carolina, Obamacare. Bookmark the permalink. Leave a comment.

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