Leading Medical Groups Urge Congress to Stop Steep
Doctors treating Medicaid patients face big pay cut
in 2015, way below pay for treating Medicare patients
27, 2014 - Doctors representing four major physician organizations are
knocking on doors in Washington today to try and preserve the current
law of payment parity for primary care and immunization services under
Medicaid for at least two years. The law, set to expire at the end of
this year, mandates that doctors treating Medicaid patients – the
poorest patients – be paid the same as what is paid doctors treating
Medicare patients with the same procedure.
If this pay parity is not extended, the nation’s
primary care physicians say they will face an average pay cut of 41
cents on the dollar for providing primary care services, such as office
visits for the treatment of chronic diseases like high blood pressure
and diabetes to the more than 65 million Americans enrolled in Medicaid.
Collectively representing nearly 423,000
physicians, the American Academy of Pediatrics (AAP), American Academy
of Family Physicians (AAFP), American College of Physicians (ACP) and
American Osteopathic Association (AOA) representatives are meeting with
dozens of congressional offices on Capitol Hill today, with hundreds
more meetings taking place as part of a daylong AAP advocacy training.
As a national average, physicians treating Medicaid
patients have been historically paid 59 percent of what is paid by
Medicare for the same primary care service. This payment disparity can
force pediatricians, family physicians and internal medicine doctors to
limit the number of new Medicaid patients they can afford to take on,
creating barriers for children and families in search of access to
This access barrier is especially problematic,
according to the medical groups, because Medicaid serves low-income
families as well as children and adults with special health care needs;
access to health insurance is especially important for these vulnerable
Current law increases Medicaid payments for primary
care and immunizations services to Medicare levels for calendar years
2013 and 2014, but funding for this policy expires on Jan. 1, 2015.
Leaders from the AAP, AAFP, ACP and AOA are in
Washington today to urge support for a bill sponsored by Senators
Sherrod Brown (D-Ohio) and Patty Murray (D-Wash.), the Ensuring Access
to Primary Care for Women & Children Act (S. 2694), which would extend
Medicaid-Medicare payment parity for two more years.
“Since children make up nearly half of all Medicaid
patients, increasing Medicaid payments for primary care services helps
improve access to care for children,” said AAP President James M.
Perrin, MD, FAAP.
“The improved Medicaid payment rates over the last
two years have already helped pediatricians better address the needs of
children in their communities by providing the resources and support
they need to give the best possible care to their patients. In order to
sustain improved access to care for children in Medicaid, the parity
payments must be extended.”
“Without congressional action to extend Medicaid
parity with Medicare, primary care physicians will see an abrupt cut to
Medicaid payments for the care they provide to low-income families,”
said AAFP President Robert Wergin, MD, FAAFP.
“This could wipe out the progress of ensuring that
low-income Americans have access to primary medical care. We know from
research that when Medicaid beneficiaries cannot find a physician who
accepts new Medicaid patients, they face the same access problems as
those who have no insurance. They are less likely to have a usual source
of care, which contributes to unnecessary fragmentation and duplication
“We are speaking for our patients when we urge
senators and representatives to do the right thing and see that current
Medicaid payment rates for primary care and immunizations services are
maintained,” said Wayne J. Riley, MD, MPH, MBA, MACP, president-elect of
“If Congress fails to take action to extend this
vital program, physician participation will be undermined, and patients
will face barriers in accessing primary care."
An April 2014 ACP-member survey found that of the
respondents who indicated they had enrolled in the pay parity program
via their state Medicaid programs, 46 percent would accept fewer
Medicaid patients in 2015 or drop out of Medicaid entirely in 2015 if
the program was allowed to expire on Dec. 31, 2014.
“The number of eligible Medicaid beneficiaries,
among the most vulnerable patient populations, continues to increase
throughout the country,” said AOA President Robert S. Juhasz, DO.
“Ensuring access to care from physicians to treat the needs of these
patients is vital to improving the public health of our citizens, and we
believe Congress should extend this important payment parity policy to
“The nation’s pediatricians are joined today by
family physicians, internal medicine and osteopathic physicians with one
resounding message for Congress: unless Medicaid-Medicare payment parity
is extended this year, patients’ access to primary care will decline,”
said Dr. Perrin. “We urge our national leaders to help ensure the health
of our patients by passing the Ensuring Access to Primary Care for Women
and Children Act without delay.”
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