By Susan K. Livio/The Star-Ledger
on August 18, 2013 at 7:15 AM
TRENTON – Beginning in January, the Affordable Care Act is expected to open the door to 300,000 low-income New Jerseyans to get health coverage through Medicaid, but a recent survey found the majority of Garden State doctors won’t be willing to treat them.
Fifty-four percent of primary care doctors and 56.5 percent of specialists in New Jersey said they did not plan to accept any new Medicaid patients in the coming year — more than any other state, according to a July report in the monthly publication Health Affairs.
The report — based on a survey of 8,158 physicians in 2011 and 2012 — said “access to office-based physicians is important in helping Medicaid patients avoid relying on” costly hospital emergency rooms for their care.
Medical groups say there’s no mystery behind New Jersey doctors’ lack of interest: The state’s meager reimbursement rates are among the lowest in the country.
“Medicaid payments are not the same across the country, which doesn’t make sense to anyone,” said Ruth Schulze, president of the Medical Society of New Jersey and an obstetrician and gynecologist (OB/GYN) in Woodcliff Lake. “New Jersey sees a huge proportion of Medicaid patients but, unfortunately, our payments are one of the lowest in the nation.”
While Medicaid is a federal program, states also help pay the tab — and each determines how much doctors and other health care providers are reimbursed.
New Jersey pays a doctor $23.50 for an office visit with a Medicaid patient. But a doctor in Wyoming is paid from $67 to $95.57 depending on the complexity of the patient’s ailment. Pennsylvania’s doctor office visit rates range from $40 to $54.42. In New York, it’s $37.41 to $56.18. Across the nation, basic office visit rates range from $20.64 to $111.22, according to the Kaiser Family Foundation.
“We’ve always been ranked close to dead last in reimbursement rates for primary care doctors, and the state should do something about it,” said Raymond Castro, senior analyst from New Jersey Policy Perspective, a left-leaning research and advocacy group.
The Affordable Care Act has committed to pay for the cost of raising the rates for two years, beginning this year, to match what Medicare pays for treatment. Kaiser estimated doctors will see on average a 73 percent raise in reimbursements for most services under Medicaid. In New Jersey, doctors will get paid 109 percent more than they are now.
The problem is the federal government has delayed those raises so far this year because of federal budget cuts forced by sequestration, said Deborah Briggs, president and CEO for the New Jersey Council of Teaching Hospitals.
And any physicians considering taking on Medicaid clients might not be lured by just a two-year bump in reimbursements, said Claudine Leone, a lobbyist for the New Jersey Academy for Family Physicians.
“Some family physicians are reluctant to take on additional Medicaid patients since their practices may not be able to support the additional staff necessary if New Jersey reverts back to the lowest rates in the nation,” Leone said. “It is a difficult decision, as physicians do not want to say goodbye to patients once they have established a relationship when the payments are cut.”
Nicole Brossoie, a spokeswoman for the state Department of Human Services, which administers the state’s Medicaid program, said many doctors who accept Medicaid patients through an HMO have been able to negotiate better rates than what the pay-as-you-go plans cover.
She said the federal government expects more doctors to sign on to qualify for the higher reimbursements, then “evaluate the program at the end of the two-year period.”
Many doctors aren’t biting.
Peter Carrazzone said he has never accepted Medicaid in his 28 years as a family doctor in Bergen and Passaic counties. When the federal government announced it would raise the rates for two years, he considered it, but declined again. Two years of better rates is not enough, he said.
“A lot of Medicaid patients have a lot of problems. They are more on the complex side and take more time,” Carrazzone said. “I did not think I could do it and survive and give them the time and attention they deserve.”
Briggs said the teaching hospitals will urge the federal government to keep the rates high after the two-year period ends “for a longer-term fix.”
If something isn’t done about the meager Medicaid reimbursements, Briggs predicts people who can’t find a doctor to take their Medicaid card will simply go to the emergency room like they always have. That would derail one of the goals of the health care law: to curb expensive emergency room use.
“That would put another nail in our health crusade coffin,” she said.