NC doctors, patients face Medicaid pinch in 2015

The new year brings two new challenges for North Carolina doctors who take Medicaid, as a temporary boost from the Affordable Care Act goes away and a state cut kicks in after a year’s delay.

Hardest hit will be the family practitioners and pediatricians who are supposed to take the lead in providing better medical care for about 1.7 million low-income children and adults in North Carolina.

Those doctors could see payments drop by more than 20 percent this year as the ACA bump from 2014 ends, according to a study by the Washington-based Urban Institute, which researches issues related to poverty.

That could be bad news for patients. For instance, Dr. Rhett Brown of Novant Health Midtown Family Medicine says his practice has started restricting new Medicaid patients in anticipation of the cuts.

Twenty-seven states, including South Carolina, will use state money to extend the higher payments for primary care. But North Carolina isn’t among them.

In fact, a 3 percent cut in North Carolina’s Medicaid rates, originally slated to start in 2014, took effect Jan. 1 – and doctors may have to go back through last year’s billing and pay that money back.

“This would wreak havoc with the finances of any business,” a statement from the N.C. Medical Society says.

Things could change

Doctors say they’re watching with concern, but not panic.

“Theoretically it could be catastrophic,” said Dr. Janice Huff, assistant medical director for Community Care Partners of Greater Mecklenburg, a managed-care organization for Medicaid. She and other doctors say federal and state lawmakers are known for revising payment plans.

In other words, what officially happened Jan. 1 may not be the final result. “There are a lot of people, myself included, who are very jaded,” Huff said.

Dr. Andrew Mueller, a family practitioner who is Novant Health’s senior vice president for physician services, agrees much is up in the air.

“The hardest thing for providers and patients is going through periods of rapid change and uncertainty,” Mueller said.

The ACA, often dubbed “Obamacare,” is designed to provide coverage for low- and moderate-income families and match them with doctors who know their history and provide ongoing care. That’s not only better for their health but generally more cost-effective than treating them in emergency rooms when they fall seriously ill.

Doctors needed

But one challenge, in North Carolina and across the country, is a shortage of primary care doctors. North Carolina has less than half the number of doctors needed, according to a 2014 survey by the Kaiser Family Foundation, a health care research group.

The ACA provided federal money for a two-year increase in Medicaid payments for primary care services, matching them to the higher Medicare rates in 2013 and 2014. That ended Dec. 31.

North Carolina’s Medicaid rates were already closer to Medicare than in most states, and the state has a higher-than-average number of doctors taking Medicaid patients, the Urban Institute study shows.

That means most states saw a bigger payment bump in 2013 – and face a bigger drop this year – than North Carolina’s 20.5 percent. On average, primary care fees will drop almost 43 percent nationwide, with half a dozen big states seeing declines of more than 50 percent.

Local doctors said they haven’t seen numbers on whether the hike brought more physicians into the Medicaid fold. But some say holdouts weren’t likely to be enticed by a two-year raise. “I would suspect some providers are skeptical,” said Dr. Melissa Ratliff, 2014 president of the Mecklenburg chapter of the American Academy of Family Physicians.

Reform, but how?

For many of North Carolina’s poor, the big hurdle is getting Medicaid coverage. The ACA provided federal money to extend Medicaid to able-bodied adults earning less than the federal poverty level, but North and South Carolina are among 22 Republican-led states that have refused to do so, leaving hundreds of thousands without coverage.

With the state legislature set to convene Wednesday, Gov. Pat McCrory and state lawmakers remain at odds over how or whether to create coverage for those people. Controlling costs and improving the state’s Medicaid program is high on everyone’s agenda, though.

Meanwhile, Congress started its 2015 session last week. Physicians are watching to see whether members extend the Medicaid boost or provide any new support.

Robert Seligson, CEO of the N.C. Medical Society, said he expects “some patches,” but “if I could predict Congress, I’d be a billionaire.”

Because of the uncertainty, the effects of Medicaid cuts are likely to unfold in coming months, as it becomes clear how much of a hit doctors will take. Medical experts in Charlotte and Raleigh say small practices in impoverished rural areas are at biggest risk.

“A lot of doctors are finding it difficult to keep their practices open,” Seligson said.