I remember the day I felt like I was a “doctor.” I was rotating through my Ambulatory Clinic – a resident staffed facility that sees patients that have Medicaid or self-pay for medical care. What does self-pay mean? Well, for one reason or another, they are unable to qualify for Medicaid and are too poor to afford health insurance. (Yes, we still have this population in today’s post-ACA era.)
Back to that glorious day. I was excited because my patient’s blood pressure was finally in control. Her hypertension was an illness that had plagued her for too long. The satisfaction of helping my patient accomplish this long-term goal is inexplicable. I shared the sentiments of Rocky (movie character) as he completed the famous climb. Chronic illnesses are a marathon & not a sprint. And achieving control over it was equivocal to reaching the finish line. This feeling convinced me that I wanted to be a Primary Care Physician (PCP). As I began understanding the art of Primary Care, I realized that a significant portion of it was influenced by Health Policy. I became interested in policies related to financial compensation of Primary Care Physicians and its effects on population health. I learned that under Obamacare Medicaid reimbursement had significantly increased! It was a reason to celebrate…finally NYS would not be the third-lowest state in Medicaid reimbursements to Primary Care Physicians. For every $1 given by Medicare, Medicaid would also give $1 for the same diagnosis (up from $0.42). This is known as Medicaid Parity. And, it would certainly increase the PCP workforce for NYS, which means that our patients would have more time with their physician per visit. Wonderful news, right? Of course! But I forgot that all good things come to an end.
Starting January 1, 2015, Medicaid will no longer reimburse at Medicare levels. This translates into a 58% decrease in reimbursement for Primary Care Physicians from Medicaid. Under the environment of Medicaid expansion, our patient population will need increasing numbers of Primary Care Physicians. In a recent NY-ACP survey (April 2014), 46% of PCPs indicated that they had recently began to see Medicaid patients by enrolling in the Medicaid Primary Care Pay Parity Program. The same respondents said that they were likely to accept fewer Medicaid patients in 2015 (approx 40%) if the Parity Program was not extended. This potential loss of physician workforce is expected nationwide because the Parity Program was a federally sponsored initiative. It also effects population health because decrease in physicians causes increased wait-times for diagnosis & treatment of illnesses, increased patient to physician ratio, and of course decreased allotted time per patient.
This is where my Health Policy conscience rises up and urges me to spread the word. It is imperative that patients and physicians advocate for continuing the Parity Program because we need good physicians to take care of our population. We cannot afford to lose physicians at such a critical time when our Medicaid population is expanding significantly. It would a significant missed opportunity if these patients go undiagnosed or untreated. If the goal of Obamacare is to improve the health status of Americans, we need to encourage and retain PCPs, so that we can help our communities be healthier.
If you are interested in supporting the Parity Program, there is legislation in the US Congress “Ensuring Access to Primary Care for Women & Children Act” (S.2694) that looks to continue the federal funding through 2016. I urge you to at least read & become knowledgeable about the legislation before you decide to support or refute it. Medicaid Parity Bill in US Congress. If you want to Support: Click Here!
“He is the best physician who is the most ingenious inspirer of hope.” – Samuel Taylor Coleridge