With so much political rhetoric aimed at the Affordable Care Act these days and many openly hoping the Supreme Court will throw the baby out with the individual mandate bathwater, the law’s strong points very often get drowned out by the static and noise.
Such was the case last month when the U.S. Department of Health and Human Services announced it would pony up $11 billion over two years to allow states to bring Medicaid payments for primary care services in line with those paid by Medicare.
To some $11 billion may seem like a lot of money and that it is too much to spend in these tight fiscal times, but they are wrong. Further, those who devote their time to worrying and carping about one central tenet of ACA – the individual mandate – appear to be missing the second pillar: that primary care and the relationship between a doctor and the patient is the bedrock of effective healthcare and needs to be moved to the forefront of the country’s efforts to improve health and cut costs.
Doctors at the front line of healthcare will tell you that for the better part of the last three decades, primary care doctors have been marginalized both by payment designs and stature within the practice of medicine.
Young men and women entering medical school soon learn the score. Other medical specialties pay much, much more for them to practice medicine and often don’t come with some of the headaches associated with actually running a business. Combine this with the fact that payment for primary care services from both private and public payers have been deteriorating since the 1980s and it is not hard to see why 24 percent of students entering medical school intend to become primary care doctors, yet on graduation only 9 percent do.
So is the $11 billion a lot? Well, yes, but it is also less than chump change compared to total healthcare spending, which is well over $2.6 trillion annually. But it is a start and perhaps even a reversal of the long trend that has led to projected primary care doctor shortages of more than 60,000 within the next ten years.
As Roland Geortz, MD, board chair of the American Academy of Family Physicians pointed out recently: “You can’t take care of patients unless you have the workforce to do it.”
In the short-term, the money is intended to at least maintain the number of doctors willing to treat Medicaid members. While Medicaid payment rates vary from state to state, on average, doctors across the country get paid only two-thirds the amount from Medicaid as they do when providing the same service to a Medicare patient.
Under the proposed rule, the federal government will pick up 100 percent of the difference between Medicaid payments and the corresponding rate paid under Medicare for a number of primary care and preventive services.
“The regulations that we are proposing today implement a provision of the Affordable Care Act that is very explicitly designed to promote primary care and in the Medicaid program in particular,” said Cindy Mann, deputy administrator for the Centers for Medicare & Medicaid Services in a conference call announcing the proposed rule.
Medicaid directors and the physicians who provide care to Medicaid patients see the increased payments as the first step in correcting this long-running discrepancy.
“I know it is true in Arkansas and I’m sure it is true in other states, this boost in reimbursement to primary care we see as an investment in Medicaid’s relationship with providers at a time when that relationship is more important than ever,” said Andy Allison, director of the Arkansas Medicaid program.
Even more importantly, Goertz said medical school student interest in primary care seems to be on the rise, if student membership in AAFP, which has increased for three straight years, is any indication.
As a primary care doctor “you want your role to be respected for what it can do to make the system better,” Goertz noted.
And while the funding won’t solve all of the access and pay inequities, it is at least one small step in the right direction.