CMS ups Medicaid PCP pay, but survey finds drop in independent physicians

Primary care physicians (PCP) serving Medicaid beneficiaries will start receiving higher payments in January 2013 thanks to a final rule published on Nov. 1.

The rule implements the part of the Patient Protection and Affordable Care Act designed to raise rates to ensure doctors are paid the same for treating Medicare and Medicaid patients but does not raise costs for states.

In addition to payment improvements, the healthcare law includes numerous initiatives designed to bolster primary care and strengthen the primary care workforce, including an expansion of medical residency positions for primary care physicians, new investments in physician assistant and nurse practitioner training and an unprecedented expansion of the National Health Service, which provides scholarships and loan repayments to primary care providers who practice in underserved areas.

It remains to be seen how much impact this rule will have on the looming shortage of primary care providers and how physicians practice in general. An increasing number of U.S. doctors are expected to leave private practice for hospital employment over the next 18 months, due to rising costs and technology mandates, according to a report from Accenture. By the end of 2013, Accenture also estimates that one-third of doctors remaining independent will offer patients subscription-based services, such as telemedicine or online consultations in an effort to sustain profit. That trend that is expected to increase three-fold over the next three years. 

Over the past decade, the number of independent U.S. physicians has dropped dramatically, from 57 percent in 2000 to 39 percent in 2012. By the end of 2013, Accenture predicts this number will likely drop further, to 36 percent, and is 3.6 percent lower than Accenture’s 2011 report. The Accenture findings resulted from extensive market analysis on U.S. physician employment and a survey of 204 physicians in independent practice that was conducted in May.

Among the other key findings of the survey:

• The majority (87 percent) of physicians surveyed cited the cost and expense of running a business as a chief concern.
• Most doctors (65 percent) joining health systems said they expect to make the same or less compensation than in private practice.
• Sixty-one percent cited business operations as a main reason for seeking hospital employment rather than remaining independent.
• More than half of doctors (53 percent) cited EHR requirements as a main reason for leaving private practice.

For more information, read the complete final rule and Accenture report.