A proposed rule by the U.S. Department of Health and Human Services would give states more than $11 billion in new funds to boost payments to primary care physicians serving Medicaid patients, but a New Jersey health care expert said it’s not clear if the money will end up in the hands of the state’s doctors.
“The state has made it mandatory that almost everyone with Medicaid has to take a managed Medicaid plan administrated by commercial payers, and they don’t always pass on the extra money that comes to them from the federal and state governments to primary care offices,” said Richard Corson, a board member of the New Jersey Academy of Family Physicians. “Ideally, there would be a 100 percent flow of the funds to primary care doctors, but bureaucracy has a way of making that not happen.”
According to the HHS, the estimated $5.52 billion increase in 2013 and $5.66 billion increase in 2014 would bring Medicaid primary care service fees in line with those currently paid by Medicare. Currently, regardless of the level of care administered, Medicaid pays doctors $22 for an office visit, while Medicare pays them $150, Corson said.
According to Corson, Medicare also pays an extra 10 percent quarterly incentive to primary care doctors, which is based on the number of patients they treat and productivity. Corson said his family medicine practice in Hillsborough only takes Medicaid patients if they have Medicare as their primary insurance. He does not accept Medicaid as a primary insurance because it pays doctors poorly, and he finds it difficult to get Medicaid patients specialty care.
“Primary care in New Jersey is in a very distressed state right now. There’s not enough money to sustain doctors that are here, and people are not going into primary care because of financial status,” Corson said. “This money is a drop in the bucket. The economic environment must be changed.”
Corson said his practice’s patient-centered medical home model piloted by insurance companies and the Centers for Medicaid Services’ Shared Savings Program — which granted approval to three accountable-care organizations in the state last month — will be more effective in growing the primary care industry and getting primary-care physicians and specialists to accept Medicaid in the future.
“Any movement in the right direction is a good movement, even if it’s small,” Corson said. “But that will only work if there’s incentive to be a primary-care doctor.”