Patients' access to primary care at risk if payment parity policy allowed to expire
October 27, 2014
WASHINGTON, DC-The American Academy of Pediatrics (AAP), American Academy of Family Physicians (AAFP), American College of Physicians (ACP) and American Osteopathic Association (AOA) convene today in Washington, DC to urge Congress to extend current-law payment parity for primary care and immunization services under Medicaid for at least two years. Absent congressional action, federal support for this policy runs out at the end of the year. Collectively representing nearly 423,000 physicians, the four groups are meeting with dozens of congressional offices on Capitol Hill today, with hundreds more meetings taking place as part of a daylong AAP advocacy training.
As a national average, physicians treating Medicaid patients have been historically paid 59 percent of what is paid by Medicare for the same primary care service. This payment disparity can force pediatricians, family physicians and internal medicine doctors to limit the number of new Medicaid patients they can afford to take on, creating barriers for children and families in search of access to medical care. This access barrier is especially problematic because Medicaid serves low-income families as well as children and adults with special health care needs; access to health insurance is especially important for these vulnerable populations.
Current law increases Medicaid payments for primary care and immunizations services to Medicare levels for calendar years 2013 and 2014, but funding for this policy expires on Jan. 1, 2015. Leaders from the AAP, AAFP, ACP and AOA are in Washington today to urge support for a bill sponsored by Senators Sherrod Brown (D-Ohio) and Patty Murray (D-Wash.), the Ensuring Access to Primary Care for Women & Children Act (S. 2694), which would extend Medicaid-Medicare payment parity for two more years.
"Since children make up nearly half of all Medicaid patients, increasing Medicaid payments for primary care services helps improve access to care for children," said AAP President James M. Perrin, MD, FAAP. "The improved Medicaid payment rates over the last two years have already helped pediatricians better address the needs of children in their communities by providing the resources and support they need to give the best possible care to their patients. In order to sustain improved access to care for children in Medicaid, the parity payments must be extended."
"Without congressional action to extend Medicaid parity with Medicare, primary care physicians will see an abrupt cut to Medicaid payments for the care they provide to low-income families," said AAFP President Robert Wergin, MD, FAAFP. "This could wipe out the progress of ensuring that low-income Americans have access to primary medical care. We know from research that when Medicaid beneficiaries cannot find a physician who accepts new Medicaid patients, they face the same access problems as those who have no insurance. They are less likely to have a usual source of care, which contributes to unnecessary fragmentation and duplication of services."
"We are speaking for our patients when we urge senators and representatives to do the right thing and see that current Medicaid payment rates for primary care and immunizations services are maintained," said Wayne J. Riley, MD, MPH, MBA, MACP, president-elect of ACP. "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 primary care physicians will face an average pay cut of 41 cents on the dollar for providing primary care 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.
"The number of eligible Medicaid beneficiaries, among the most vulnerable patient populations, continues to increase throughout the country," said AOA President Robert S. Juhasz, DO. "Ensuring access to care from physicians to treat the needs of these patients is vital to improving the public health of our citizens, and we believe Congress should extend this important payment parity policy to that end."
"The nation's pediatricians are joined today by family physicians, internal medicine and osteopathic physicians with one resounding message for Congress: unless Medicaid-Medicare payment parity is extended this year, patients' access to primary care will decline," said Dr. Perrin. "We urge our national leaders to help ensure the health of our patients by passing the Ensuring Access to Primary Care for Women and Children Act without delay."
About the American Academy of Pediatrics
The American Academy of Pediatrics is an organization of 62,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults. For more information, visit http://www.aap.org or follow @AmerAcadPeds on Twitter and Facebook.
About the American Academy of Family
Founded in 1947, the AAFP represents 115,900 physicians and medical students nationwide. It is the only medical society devoted solely to primary care. Approximately one in four of all office visits are made to family physicians. That is nearly 214 million office visits each year - nearly 74 million more than the next largest medical specialty. Today, family physicians provide more care for America's underserved and rural populations than any other medical specialty. Family medicine's cornerstone is an ongoing, personal patient-physician relationship focused on integrated care.
To learn more about the specialty of family medicine, the AAFP's positions on issues and clinical care, and for downloadable multi-media highlighting family medicine, visit www.aafp.org/media. For information about health care, health conditions, and wellness, please visit the AAFP's award-winning consumer website, www.familydoctor.org.
About the American College of Physicians
The American College of Physicians is the largest medical specialty organization and the second-largest physician group in the United States. ACP members include 141,000 internal medicine physicians (internists), related subspecialists, and medical students. Internal medicine physicians are specialists who apply scientific knowledge and clinical expertise to the diagnosis, treatment, and compassionate care of adults across the spectrum from health to complex illness. Follow ACP on Twitter and Facebook.
About the American Osteopathic
The American Osteopathic Association (AOA) represents more than 104,000 osteopathic physicians (DOs) and osteopathic medical students; promotes public health; encourages scientific research; serves as the primary certifying body for DOs; is the accrediting agency for osteopathic medical schools; and has federal authority to accredit hospitals and other health care facilities. More information on DOs/osteopathic medicine can be found at www.osteopathic.org.
American Academy of Pediatrics: Jamie Poslosky, firstname.lastname@example.org, 202-724-3301
American Academy of Family Physicians: Leslie Champlin, Lchampli@aafp.org, 800-274-2237, ext. 5224
American College of Physicians: David B. Kinsman, email@example.com, 202-261-4554
American Osteopathic Association: Nicole Grady, firstname.lastname@example.org, 312-593-6897