Expert: Boosting Medicaid reimbursements may not be enough enticement for doctors

November 05. 2012 1:42PM


Some physicians are wary about accepting new Medicaid patients, even though in 2013 and 2014, primary care physicians who see Medicaid patients will be reimbursed at Medicare rates thanks to the final rules introduced earlier this month by the Centers for Medicare and Medicaid Services.

Even though New Jersey has one of the lowest Medicaid reimbursement rates in the nation, Dr. Mary Campagnolo, president of the Medical Society of New Jersey, thinks the two-year window will not be enough to encourage physicians to open their practices to Medicaid patients.

"The concern physicians have in that regard would be potentially you open up your practice to all of these extra patients and then unfortunately the rate will change in two years" to a lower amount, Campagnolo said. The uncertainty of the reimbursement hike is "still a hindrance that physicians might be not willing to jump into anything they're not already accepting."

Campagnolo said physicians who already see Medicaid patients will benefit greatly from the increased reimbursement, as Medicare negotiated rates are generally higher than even private payer managed-care contract rates.

The change to Medicare rates for Medicaid patients is part of the Affordable Care Act, and aims to open access to primary care for Medicaid patients at family medicine, general internal medicine or pediatric care offices. The higher payment will also be available to nurse practitioners and specialists, like pediatric cardiologists, that provide primary care services.

One of the greatest concerns about implementing the Affordable Care Act is whether physicians will accept the newly insured patients created by expanding Medicaid. The goal of increasing Medicaid payments to Medicare levels is to incentivize physicians to take on more Medicaid patients.

The federal government will reimburse states 100 percent for the increased Medicaid reimbursements, according to the CMS rule.


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