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Have Medicare and Medicaid Pay Cuts in 2015 been a huge Challenge for physicians?

November 30, 2015


A string of pay cuts had to be contended to by physicians in 2015 leaving them struggling to manage electronic health records. Added to this are the woes related to new quality measures and countless changes in the reimbursement formulae of Medicaid and Medicare.

There still are quite a few doctors who treat Medicare patients, although there has been a reduction of nearly 21.2% in Medicare reimbursement rates, going by the statistics of the Department of Health and Human Services. A study conducted by the Urban Institute indicates that primary healthcare physicians who are still taking in Medicaid patients can expect a reduction of not less than 42%.

Given this scenario, the challenge is indeed daunting, and one wonders how badly this will affect access to medical care in the future. The Affordable Care Act, dubbed Obamacare did help increase Medicaid reimbursement rates for primary care physicians almost at par with the level of what Medicare offered. Alas, this for merely two years, 2013 and 2014.

The statistics are quite interesting – While Medicare, which is primarily for providing health coverage for seniors pays up to 80% when compared to private health insurers, Medicaid, which takes care of the economically weaker section pays a paltry 56%. However, the focus has been on increasing Medicaid to a lot more needy people, and the Democrats were prepared to go to any lengths to achieve this. All that is over now and we are back to square A with lower Medicaid reimbursement rates back in force.

Medicaid cuts will certainly have an adverse impact on family physicians, especially the ones who went ahead and increased Medicaid beneficiaries just because of the difference in rates when compared to Medicare. According to Dr. Robert Wergin of American Academy of Family Physicians almost half the respondents who participated in a survey reported increase in Medicaid patients. Doctors are also quite unhappy with the 2% reduction in pay, no thanks to the sequester.

Physicians still want to provide quality healthcare to their patients, however the cumbersome and misaligned regulatory programs take up most of their valued time, leaving them with hardly any time to devote to their patients. Doctors today are wont to investing in health information technology, and in delivery reforms, which can certainly lead to improved care for patients.

There seems to be a misalignment between regulations like Meaningful Use Program (MU), Value Based Modifier Program (VBM) and Physician Quality Reporting System (PQRS) resulting in physicians having to submit reports multiple times in different formats. This is not only time consuming, but also leaves them a confused lot. In addition to this, physicians need to contend with annual changes and scheduled phase-ins for every single program, which makes compliance all the more difficult. The need of the hour is for the Centers for Medicaid and Medicare Services (CMS) to take steps to simplify regulations and synchronize them.

Although this is a vexing issue most physicians are not giving up though over 257,000 of them will be paid 1% less through reimbursement from Medicare. This is because they did not comply with “Meaningful Use” of electronic health records as far back as 2013.


Category : EMR / EHR / Health IT