In a new study that could prove troublesome for the Affordable Care Act’s Medicaid expansions, Sandra Decker, an economist with the Centers for Disease Control (CDC) has reviewed data from 2011 suggesting that three in ten primary care physicians would decline to see new Medicaid patients next year. 69% of physicians said they would accept new Medicaid patients, which runs considerably lower than the 81% for private insurance and 83% for Medicare patients.
The reasoning behind physicians declining to see new Medicaid patients? Reimbursement. Many state Medicaid programs facing budget shortfalls are choosing to cut reimbursements as a popular option for legislators and Medicaid directors to enact. CDC economist Decker uses the chart below to illustrate the relationship between reimbursement levels and physician participation in the program. In Alaska, physicians receive 50% more than typical Medicare reimbursement levels and enjoy nearly 90% participation from physicians. New Jersey, on the other hand, pays just 40% of Medicare reimbursement and receives only about 30% participation from physicians.
Graphic courtesy of the Washington Post
So, how does all of this effect orthotics and prosthetics? Needed physician reimbursements are typically tied to the same budget shortfalls as other provider cuts in Medicaid. The question becomes, with an anticipated 16 million new Medicaid recipients entering the market due to the Affordable Care Act, will there will be enough providers to treat the huge influx of new patients and whether current reimbursements will be able to continue in the face of increasing budget pressure after the initial three years of the ACA funding. The ACA increases primary care reimbursements for the first few years of the expansion to entice physicians, but not after, so many physicians are questioning whether it is a wise business decision to see new Medicaid patients; orthotists and prosthetists will face this same dilemma. However, fortunately for our profession, O&P reimbursements have held relatively consistent for the past few years.
So, expanded Medicaid due to the Affordable Care Act could potentially be a way to 16 million new patients, but only if the entire system continues to operate with a smaller share of physicians/providers choosing to treat the new enrollees and with likely decreasing reimbursements moving forward.
OPGA Government Relations will continue to monitor the ACA Medicaid expansions and provide updates as key deadlines and policy initiatives continue throughout the year.
Sandra Decker’s full report can be found here.