September 18, 2012 in
Uncategorized by support Team | Comments Off on Potential Impact of the 2013 ACA changes in Medicaid Reimbursements to Pediatric Practices
We hear that children are the most important aspect of our Healthcare system and that preventive care has the best return on our health care dollar. So, why are Pediatricians continuously receiving the lowest average pay when compared to other physician specialties? There are many reasons for the low reimbursements including the significant gap in payments between Medicaid and Medicare. Family Practice and Internists rely both on Medicare and Medicaid while Pediatricians, due to almost all their patients being
Patients without a primary Pediatrician seek some of their care at the Hospital ER. Besides breaking the Medical Home concept, treating at the hospital is far more expensive than in a Pediatric office. The formers of the Affordable Care Act made a choice to invest in primary care versus urgent care by changing the law so that Medicaid reimbursements = Medicare Reimbursements. This change should help providers increase their panel of Medicaid patients and should benefit the cost curve as well. Lastly, the patients should see increased access to a Pediatrician. States would see >$10B in new funds from Health and Human Services to pay for the expanded cost (this is an investment by the Federal Government). The goal of this investment is to reward the primary care physician for preventive care.
When will this take effect? Starting in 2013, the reimbursements for Medicaid are to increase to Medicare Levels.
What does this mean? There are a few states that Medicaid currently pays above Medicare (Alaska, Wyoming) according to some reach by Sandra Decker whom is an Economics at the CDC (see article in the Washington Post dated August 6, 2012 http://www.washingtonpost.com/blogs/ezra-klein/wp/2012/08/06/study-one-third-of-doctors-wouldnt-take-new-medicaid-patients-last-year/ )
Overall, statehealthfacts.org by the Kaiser Family Foundation (http://www.statehealthfacts.org/comparetable.jsp?ind=196&cat=4 ) shows that Medicare to Medicaid Fee index is .66 for the United States. The lowest states are Road Island (.36), New York (.36), New Jersey (.41), District of Columbia (.47) and CA (.47).
Will the New Medicaid pay the same as commercial Insurance? Generally, the answer is no. The reason is that although Sick and Well visits should, in most states, see an increase in reimbursement being paid, there will continue to be a significant gap in payments for Vaccine Administration codes by Medicaid. Recommend read the press release below. If your practice currently does not accept Medicaid Patients due to the low reimbursements, now is the time to consider changing the policy for the practice.
September 5, 2012 in
Uncategorized by support Team | 2 Comments
With Healthcare costs increasing at a rapid rate in the United States, there are a number of payment models being investigated that look to encourage preventative care while reducing costs. Although most practices generate the majority of their revenue from Fee for Service insurance products, there is much talk as well as movement related to Accountable Care Organizations (ACOs). The concept of ACOs is that an organization manages a large group of providers and hospital systems to provide patient care. The ACO and the providers would be compensated for management of a population. The leaders in this field are exploring many different methods for payment – a set fee per patient for all care, bundled payment per episode of care as well as other risk sharing arrangements. ACOs are most thought about as hospital systems that purchased provider groups (e.g. Integrated Delivery Systems) and form an ACO entity. In this case, the Pediatric Group would need to be owned by the hospital system to participate in the ACO.
Although the Medicare Shared Savings Program ACO sponsored by the Centers for Medicare and Medicaid Services (CMS) has the most publicity, the commercial payers are beginning to experiment with ACO payment models as well. The Medicare Shared Savings Program ACO shares the savings of ACO effort between the ACO and CMS (the providers continue to receive Fee for Service payments at this time).
There is another type of ACO model known as the Virtual ACO or community ACO. This model would be an organization that is the contracting agent with payers and would like to privately owned practices. For example, ABC Pediatrics (privately own), could participate in a virtual ACO without selling their practice. The virtual ACO would develop the guidelines on how to participate as well as the payment stream. There is much question as to how this will impact Pediatrics. The good news is that private practices should not be required to sell their practices as the ACO model evolves.
Practices and practice managers should continue to keep an eye on the payment methods in the field. Improper coding as well as low collection rate continues to be a very common issue with Practices that if managed appropriately, optimize the revenue to the practice. In Pediatrics, this requires a team that receives routing training in Pediatric coding, systems that gain intelligence as payers change reimbursement policies and consistently reporting and follow-up. So although there is much talk and experimentation with new payment models, most practices need to look how to appropriately manage the revenue cycle in today’s payment system.