Medicaid payments to primary care doctors will rise under new regulation

By N.C. Aizenman, Published: May 9 for The Washington Post

Primary care doctors could get a pay raise next year for treating Medicaid patients, under a rule announced by the Obama administration Wednesday.

The proposed regulation implements a two-year pay increase included in the 2010 health-care law. The increase, effective in 2013 and 2014, brings primary care fees for Medicaid, which covers indigent patients, in line with those for Medicare, which insures the elderly and some disabled patients.

Although Medicaid is jointly funded by states and the federal government, the pay boost would be covered entirely with federal dollars totaling more than $11 billion over the two years it would be in effect.

Congress automatically appropriated those funds when it adopted the health-care law, so it will not need to act now.

However, the provision is among hundreds that could be instantly nullified if the Supreme Court decides to overturn the law in its entirety when it rules on the constitutional challenge. The court heard arguments on the case in March, and a decision is expected late next month.

The pay raise is one of several attempts in the law to address a fundamental challenge in U.S. health-care: Because primary care doctors focus on preventive care, they offer the best hope of curbing the nation’s health spending. Yet they are paid far less than specialists, contributing to a shortage of primary care doctors that is projected to grow with the aging of baby boomers, the retirement of physicians and an expected influx of more than 30 million Americans who will gain insurance through the health-care law beginning in 2014.

The Association of American Medical Colleges (AAMC) has estimated that by 2020 the shortage of primary care doctors will reach 45,400.

The problem is most acute for patients covered by Medicaid, which pays substantially less than Medicare, let alone private insurers. And about 17 million of those newly insured by the law after 2014 will be covered by Medicaid.

In a statement Wednesday, Marilyn Tavenner, who heads the agency that administers Medicaid, described the pay raise as “an important tool for states to ensure their primary care networks are prepared for increased enrollment as the health care law is implemented.”

“Today’s action will help encourage primary care physicians to continue and expand their efforts to provide checkups, preventive screenings, vaccines, and other care to Medicaid beneficiaries,” she said.

Administration officials also noted that the law has already increased Medicare payments to primary care doctors — awarding more than 150,000 physicians almost $560 million in additional compensation in 2011.

Officials also pointed to a range of other initiatives in the law to bolster the primary care workforce, such as increasing primary care residency slots and offering scholarships and other incentives to medical professionals willing to work in under-served areas.

Atul Grover, chief advocacy officer for the AAMC, praised the Medicaid pay boost.

“I don’t think we’re going to solve the problem of access in this one short provision. But it’s a step in the right direction.”

Still, he said, “it’s just two years. So what do you do after those two years are up?”

Denton Has Concerns About More Private Medicaid Operators in Louisville

by Kenny Colston on May 10, 2012

The problems with privatized Medicaid in Eastern and Western Kentucky could be coming to Louisville.

Passport Health Plan has run Medicaid in Louisville and the surrounding area for more than a decade. The system was the model for last year’s Medicaid privatization, which brought three new Medicaid management companies into the state.

The federal government has ordered the state to open the Passport region to competition by next year. But Medicaid privatization isn’t working too well in the rest of the state. Hospital officials claim two of the private companies aren’t paying enough to reimburse Medicaid-covered care. The private operators say they are only adhering to their contracts with the state.

“Let’s make sure we have a plan,” says Senate Health and Welfare Committee Chairwoman Julie Denton. “If we are going to be bidding out with the Passport region for next year, starting January 1st, the Cabinet sure as heck better be working on an RFP and putting it together in a more thoughtful and steady fashion than they did the Medicaid managed care RFP for last year.”

The state has until July 1 to tell the federal government its plan to open Louisville to competition. But the Cabinet for Health and Family Services hasn’t yet begun work on the plan.

The current three statewide operators all have offices in Louisville, making them obviously competition partners for the region. But Denton says she’s not sure bringing those three in is a good idea.

“I don’t think they can just take three bids from the three MCOs and open those up and let those three MCOs in. And frankly with the way Coventry has been working thus far, I have no interest in letting them into the Passport region,” she says.

Currently, many healthcare systems are having contract issues with CoventryCares, one of the three new statewide MCOs. Coventry officials say they need more operating money and the company is looking to providers and patients to recoup profits.  That has led to lawsuits and threats from lawmakers that Coventry could be barred from operating in the commonwealth.

Coventry Cares wants to renegotiate Medicaid contract

By Tom Loftus | The Courier-Journal

FRANKFORT, Ky. — Coventry Cares, one of Kentucky’s three new Medicaid managed care organizations, has notified Baptist Healthcare System it must renegotiate its contract with the system or allow the contract to expire Nov. 1.

Coventry has sent a similar notification to King’s Daughters Medical Center in Ashland where its contract expires much sooner — May 26.

Matt Eyles, spokesman for Coventry, said the notices were sent in recent weeks because “after having a few months experience under the contracts … the kind of total costs we’re seeing are really much higher than we expected.”

In April Coventry said it would terminate its contract with Appalachian Regional Healthcare this month. But ARH, which runs eight Eastern Kentucky hospitals, sued Coventry in federal court to stop the move. Last week the two sides agreed to a continuation of the contract through June 30.

The moves by the Maryland-based Coventry to re-negotiate or terminate contracts with some of its hospitals are the latest bumps in the transition of Kentucky’s Medicaid program to three new managed care companies.

Audrey Tayse Haynes, secretary of the Kentucky Health and Family Services Cabinet, called Coventry’s actions “concerning.”

But Haynes said she sees no risk to Kentucky’s Medicaid recipients.

“There’s no risk for a couple of reasons. A Medicaid member is able to switch from one of the companies to the other two companies if they choose,” Haynes said. “Secondly, we as a cabinet are monitoring quite closely how these negotiations go.”

Eyles and spokespersons for Baptist Healthcare and King’s Daughters said they hope to resolve problems before current contracts expire.

Kit Fullenlove, the spokeswoman for Baptist Healthcare, said “we’re optimistic we can resolve this.”

Baptist Healthcare System owns five hospitals in Kentucky, including Baptist Hospital East in Louisville and Baptist Hospital Northeast in La Grange.

But Medicaid patients at those two hospitals would not be affected by Coventry Cares’ effort to renegotiate with Baptist because Passport Health Plan is the Medicaid managed care organization in Jefferson County and 15 surrounding counties.

Passport has been the exclusive managed care organization for the Jefferson County region for more than a decade.

But last year, in an effort to save hundreds of millions of dollars, the Beshear administration advertised for bids and eventually awarded contracts to three companies that now compete to manage the care of Kentucky’s Medicaid population outside Passort’s 16-county region. The two managed care companies other than Coventry Cares are Well Care and Kentucky Spirit.

Tom Dearing, of King’s Daughters, said he is “hopeful” that ongoing talks with Coventry and state Medicaid officials will result in no termination of the contract. “In our view, Coventry is putting profits ahead of lives in Eastern Kentucky by leaving potentially thousands of Medicaid patients without adequate health care options,” Dearing said.

Eyles disputed that comment. “We are committed to having a high quality effective provider network that is adequate and makes sure all of our members have access to the right care at the right time in the right setting,” Eyles said. “But we have to do it in a way that balances all of the challenges that we’re facing as well.”|newswell|text|Home|s