Dr. Sean Lynch is forced to turn away as many as seven low-income patients every day, and that number could soon grow.
For the past two years, Lynch and other Georgia doctors have received more money for treating Medicaid patients as part of a program created by the Affordable Care Act. Its goal: increase access to primary care services for the poor. The pay bump has enabled some doctors to see greater numbers of people on Medicaid, which doesn’t pay enough to cover the actual cost of care.
But the reimbursement hike — fully paid for by the federal government for two years — is set to end on Dec. 31 unless the state opts to extend the increase with its own money. Six states plan to do that, including Alabama and Mississippi. Like Georgia, both Southern states have refused to expand Medicaid as called for by the health care law.
But Georgia leaders have not yet decided whether to continue the pay increase. Maintaining it would cost the state an estimated $70 million annually, state legislators say.
“It’s important to make it affordable for doctors to take Medicaid,” said state Rep. Pat Gardner, D-Atlanta, who supports the health care law. “We desperately need primary care doctors for children.”
Other state lawmakers, however, think the price tag for taxpayers is too high.
Sen. Judson Hill, R-Marietta, said he supports doctors being fully compensated for Medicaid and Medicare services, but calls higher federal payments a temporary fix to force states to make up the difference.
“I would oppose the state being forced to pick up the $70 million fee,” he said.
Under the pay-bump program, Georgia doctors have received about $271 million in Medicaid reimbursements since the beginning of 2013, a 40 percent jump from before the higher fees were implemented, according to the state Department of Community Health. Medicaid covers about 1.8 million poor Georgians, mostly children, pregnant women, the elderly and disabled.
“The increase has helped me to see as many patients as possible and do some diagnostic, preventative services,” said Dr. Loy Cowart, who runs a family practice in Claxton. “(Before) we had a hard time getting people mammograms, colonoscopies and diabetes screenings.”
For Lynch, the higher Medicaid payments have meant he has been able to increase the percentage of Medicaid patients at his Augusta practice from 15 percent to up to 30 percent.
He hired a nurse practitioner last summer because of increased Medicaid demand. If Georgia were to continue the increased payments, Lynch said he would hire an additional provider every year for the next few years.
“Every day we are turning away an entire provider load of patients,” he said.
Before the higher reimbursement program, Lynch had to stop accepting new Medicaid patients at some point during the year. That hasn’t been necessary in the last two years, but the office will likely stop taking new patients in the next few months in anticipation of the program ending.
“The payments only cover the overhead,” Lynch explained. “I want to care for the entire population of where I’m working, but I have to limit Medicaid to stay in business.”
If the pay increase ends, practices in rural and some urban areas of Georgia, where Medicaid is a bigger portion of business, will take a hit, said Donald Palmisano, CEO of the Medical Association of Georgia.
The problem is exacerbated by the shortage of primary care doctors, Palmisano said. Physicians are graduating from medical school with extremely high debt, which plays a role in the type of medicine they choose to practice. Statewide, the number of doctors accepting Medicaid has dropped 15 percent in the past five years.
“We’ve got to encourage physicians to go into primary care to ensure the health of Georgians,” he said.
In Dunwoody, Dr. Albert Johary said the pay increase has allowed him to spend more time with patients. He finds Medicaid patients require more time for their office visits and tend to have more complicated health problems.
“For me it’s not just about what you get as reimbursement,” Johary said. “It’s the amount of time it takes to see people in the office. Instead of seeing 20 people, now you are seeing 12 (if you accept more people on Medicaid).”
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