Filed under "news that surprised few," a new study published in the New England Journal of Medicine found that increased Medicaid reimbursement for primary care led to an increased number of appointments for beneficiaries.
"Our findings suggest that providing higher Medicaid payments is an effective strategy for ensuring access to enrollees among already participating primary care providers," the authors wrote.
By the numbers: Available primary-care appointments for Medicaid beneficiaries in the surveyed areas grew from 59% to 66% between the period of November 2012 through March 2013 and the period of May 2014 through July 2014. During that second period, states had been ordered to ratchet up their Medicaid payments, receiving around $12 billion in additional federal funding over 2013 and 2014.
Following the pay boost, appointment availability grew significantly, according to the study. Notably, the size of the reimbursement increase was correlated with the gains in appointment availability. "In the states that are what I would call the high-bump states, rates went up by, on average, 13 percentage points, and in the low-bump rates, it only went up about 4 [percentage points]," said study author Daniel Polsky, who is the executive director of the Leonard Davis Institute of Health Economics at the University of Pennsylvania.
Overall, out of 10 studied states, reimbursement rose by more than 50% during that two-year period, and appointment availability grew by almost 8 percentage points. Those gains occurred despite an uptake in enrollees: A new Urban Institute report noted that the extra pay coincided with efforts to increase Medicaid enrollment, which the report said has grown by 7.5 million people since the third quarter of 2013.
The federal funding expired at the end of last year, however, and only 15 states have said they intend to match it out of their own coffers. Fees fell 43% on average across the country, according to the Urban Institute report. 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. Physicians are feeling the squeeze as a result.
"We're not going to stop seeing Medicaid patients [but] a lot of my colleagues in private practice are feeling that pressure," said Bronx, NY-based rheumatologist Arlene Tieng.
So will this new study convince legislators that keeping Medicaid pay rates at a sustainable level for physicians is the key to improved access? It's still unclear. Providers pushed Congress aggressively to extend the pay hike, but found themselves stymied by a lack of statistically-valid data, according to American Academy of Family Physicians president Dr. Robet Wergin. With this data now in hand, providers may have a better shot at convincing lawmakers.
"I could see the reluctance to maintain the Medicaid pay bump without clear evidence that it was working," Polsky said. "But now we have the evidence. Hopefully, this will influence the priority given to adequate reimbursement for primary care in Medicaid."
Here are the biggest stories in the healthcare industry this week:
It is believed that the suspect "had some issue" with the hospital's treatment of his mother, who died November 15.
A hospital in New Jersey is currently facing an unprecedented lawsuit that could strip it of its property tax exemption—and other non-profits would be wise to pay attention.
In weird news for the week...
Singing River Health System—the same system embroiled in a pension scandal—claims that the accounting firm's negligence caused an $88-million mistake.
Did the Avera Marshall board overreach, or was it acting in the best interest of the hospital?
And here's what we were reading:
- Shameless plug: We launched two weekly newsletters this week, Healthcare Dive: Payer and Healthcare Dive: IT, to serve issuers, and CIOs and other IT professionals, respectively. If you haven't signed up yet, it's not too late.
- HHS released zip code level health insurance marketplace plan selections through January 16, 2015.
- And on Twitter, Drew Armstrong claimed to answer a nagging concern about the ACA: