Like most doctors, Arlene Tieng, a Bronx, NY-based rheumatologist, thinks a lot about how to give the best care possible to every patient who walks into her exam room.
But what she doesn't pay too much mind to is how much each of her patients' payers is going to reimburse, or whether Medicaid rates are too low. Unfortunately, her friends who run smaller private practices don't have that luxury.
"We're not going to stop seeing Medicaid patients [but] a lot of my colleagues in private practice are feeling that pressure," she says.
Just as the Affordable Care Act is prompting an influx in patients who are Medicaid beneficiaries, a growing number of physicians are stressed about how they'll survive financially by treating these patients. The Affordable Care Act's two-year pay raise for many primary care doctors ran out on Jan. 1, which resulted in fee reductions of 43% on average across the country, according to the Urban Institute. And according to Stephen Zuckerman, a health economist at the Urban Institute and co-author of the report, Medicaid payments for primary-care services could drop by 50% or more in California, Florida, New York and Pennsylvania, among other states.
Meanwhile, Medicaid enrollment grew by more than 9 million people in 2014, and could very well keep going. Which means there are more patients who need primary-care doctors, pay issues aside.
And while some states, including Maryland, Alabama, Colorado, Connecticut, Iowa and Mississippi, will continue the pay raise with their own funds for all or most primary-care circumstances, more states haven't made up their minds—leaving docs in a state of uncertainty.
It's true, some physicians have already given up and stopped accepting Medicaid patients. Others, like general internist Jane Orient, who is the executive director of the Association of American Physicians and Surgeons, are advising physicians to do so.
Orient, who operates a cash-based practice and doesn't accept insurance, says she has seen patients for free who can't afford to see her. She also sometimes makes payment arrangements if they can't pay their bills up front.
"It is really much more cost-effective to see poor patients for free than to get involved with the Medicaid bureaucracy," says Orient. “There's too much compliance paperwork, you subject yourself to fraud allegations simply for seeing and billing Medicaid patients."
Yet, while concerns over reimbursement are growing louder, there haven't been a slew of physicians shuttering their doors to Medicaid all of a sudden, notes Allison Brennan, a senior advocacy advisor for the Medical Group Management Association.
"Physicians have had a very difficult time with how many Medicaid patients they are able to treat, and that has been a longstanding issue," she says. "We don't hear people saying they're going to do a lot differently."