Unless Congress acts, patients may soon lose access to primary care

September 23, 2014, American College of Physicians

A national report showing the benefits of preventing a reduction in the rates physicians receive for providing Medicaid services was released today by the American College of Physicians (ACP). The report, "Why Congress Must Save the Medicaid Primary Care Pay Parity Program: Unless Congress Acts, Program to Ensure Access to Life-Saving Primary Care Will Expire," explains why it is critical to ensure Medicaid patients' access to internists and pediatricians (and their related subspecialists), family physicians, and obstetricians/gynecologists who provide mostly primary care.

"We are speaking for our patients when we ask senators and representatives to do the right thing and see that current Medicaid payment rates for primary care and immunizations services are maintained," said David A. Fleming, MD, MA, FACP, president of ACP. "We ask senators to co-sponsor S. 2694, the Ensuring Access to Primary Care for Women & Children Act, and representatives to introduce companion legislation in the House." The bill continues federal support for the Medicaid Primary Care Pay Parity Program, which otherwise will expire at the end of this year and trigger payment reductions to physicians who take care of many of the nation's vulnerable patients—those enrolled in Medicaid.

At its Board of Governors meeting last week, ACP unveiled a program that featured reports with parallel information for each of the states, and the District of Columbia.

The Senate bill will ensure that Medicaid payments for visits and immunizations provided by internal medicine physicians and other eligible primary care specialties will continue to be no less than the Medicare rates through 2016.

The national report notes that:

  • In the coming years, Medicaid enrollment is expected to grow. "As Medicaid enrollment increases, it is imperative that policymakers do what is necessary to ensure that our vulnerable citizens can receive the health care they need from the physicians they know and trust," said Dr. Fleming.
  • If the program is allowed to terminate, the nation's primary care physicians will face a pay reimbursement cut that may force them to reconsider the viability of participating in the Medicaid program. "The Pay Parity provision is a step in the right direction toward ensuring that no Medicaid patient goes without crucial primary care services and vaccines," said Dr. Fleming.

ACP governors received state-specific reports last week. They were asked by ACP leaders to release to local media significant findings in the reports along with personalized stories about patient access resulting from pay parity. The College's governors also were asked to be in touch with local members of Congress and state medical societies.

A letter that lauded the efforts and leadership of Senators Sherrod Brown (D-Ohio) and Patty Murray (D-Wash.) was sent on September 15 by a broad physician coalition of ACP and 20 other organizations, representing internal medicine and related subspecialties. The letter applauded the senators for introducing the Senate bill that will extend current-law payment rates under Medicaid for certain primary care and immunization services to at least the level of Medicare through 2016.

Dr. Fleming sent a letter on behalf of ACP to the senators on July 30, shortly after the bill was introduced. Also, one of several ACP Advocate Alerts that have focused on the pay parity issue was targeted at the Energy and Commerce Committee, and Ways and Means Committee, House committees that play influential roles in Medicaid, Medicare, and other health care legislation. ACP Advocates consist of more than 13,000 members who contribute to ACP's continued success on Capitol Hill.

"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. If Pay Parity is not extended, the nation's will face an average pay cut of 41 cents on the dollar for providing 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," concluded Dr. Fleming.

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