Pay Hikes for Primary-Care Doctors Scheduled

In 2013, family physicians, general internists, and pediatricians will experience some Medicare and Medicaid pay increases due to two final rules recently released by CMS.

Here’s a brief look at each of the rules and the reimbursement-related changes they include:

Higher Medicaid Pay: As a result of one of the rules, released in early November, Medicaid payments to family medicine, general internal medicine, and pediatric medicine physicians will match Medicare levels in 2013 and 2014. The higher payments also apply to primary-care services provided by nurse practitioners and physician assistants who are under the supervision of a qualifying physician.

The pay hike is meant to encourage doctors to see additional Medicaid patients. As a result of the Medicaid expansion portion of the Affordable Care Act, an additional 17 million more patients are expected to gain insurance in 2014

While the pay increase is a “step in the right direction,” AAFP President and family physician Jeffrey Cain said in a statement that the temporary nature of it is troubling.

“Unless Congress acts to permanently extend and fund this provision, a sudden return to disparate and inadequate payment for primary-care services needed by Medicaid patients after only two years will again threaten to restrict their access to such needed services,” he said. “ ... Only by extending Medicaid parity with Medicare can we ensure that these Americans continue to have uninterrupted medical care in the future.”

New Payments: The 2013 Medicare Physician Fee Schedule final rule, also released in early November, establishes that primary-care physicians will receive separate payments for coordinating a patient’s care during the 30 days after a patient is discharged from the hospital. In total, these additional care-coordination payments are expected to increase family physician pay by 7 percent, and increase pay other primary-care physician pay by 3 percent to 5 percent, according to CMS.

But it’s not all good news. Unfortunately, the final rule also notes the 26.5 percent Medicare pay cut scheduled to take place January 1 due to the flawed Sustainable Growth Rate (SGR).

"The release of the Medicare physician fee schedule rule reminds patients, physicians and Congress that the time to act to prevent looming Medicare cuts is now,” AMA President-elect and internal medicine and infectious disease specialist Ardis D. Hoven said in a statement. “... Eliminating this failed [SGR] formula will allow us to enter a period when physicians can begin transitioning to new payment and delivery models to help meet the overall goal of improving patient care and moving to a higher performing Medicare program.”