Probably the most pressing item at hand is the battle that NCCEP is facing to preserve our Medicaid reimbursement rates. NCCEP has recently met with DHHS Secretary Cansler and asked to have the 9% cut we took last year rescinded, as well as requesting no further cuts. The Secretary clearly stated that he understood our situation, as well as the amount of primary care that we provide Medicaid patients in the ED. One of the challenges facing DHHS is that the department needs to reduce its budget by 15% this year, and we need to work on many fronts to avoid additional across the board cuts that could have devastating consequences on the safety net we provide. To that end, we have developed the following strategy with talking points that follow:
- We will continue to meet with Secretary Cansler to convince him that we cannot afford any additional cuts in payments.
- We have meetings scheduled with the Medicaid physician leadership to convince them of the same.
- We will be meeting with key legislators in Raleigh to convince them of the same.
- We need to have all of our members contact and visit their legislators, write newspaper editorials, and contact local media to convince them of the same. Click here to identify your legislators.
Talking points for these audiences include the following; if meeting with your local legislators, key statistics from your hospital regarding the dollar amount of uncompensated care, both outpatient and inpatient, in your ED can be very compelling, in addition to explaining that many hospitals (including possibly your own) do not “make up” the ED group’s losses for uncompensated care:
- Primary care office visits were exempted from the 9% cut last year. While primary care offices can decide to accept Medicaid patients or not, ED groups cannot engage in financial triage. ED groups provide primary care services for hundreds of thousands of Medicaid patients every year, and should not have been singled out for reduced care for the primary care we provide.
- Further reduction in payments to providers for seeing Medicaid patients will result in fewer and fewer providers participating in the NC Medicaid program. This will force more and more Medicaid patients to seek care in the ED, which threatens to break an already overloaded emergency care system and healthcare safety net.
- Decreasing reimbursement will cause North Carolina to lose additional well qualified emergency physicians at a time when there is already a shortage of trained emergency physicians in the state.
- Emergency physician practices already bear the largest brunt of mandated care for screening medical emergencies and providing stabilizing care for all patients regardless of the ability to pay, under the federal law known as the Emergency Medical Treatment Active Labor Act (EMTALA). Any additional reduction in Medicaid payments (which are already among the lowest in the state) could cause the closing of many emergency departments in the state and cut backs in that healthcare safety net.
- Under the Patient Protection and Affordable Care Act of 2010 (PPACA), primary care physicians who are enrolled with Medicare under Specialty designations 8 (Family Practice), 11 (Internal Medicine), 37 (Pediatrics) and 38 (Geriatrics) may receive a 10% bonus payment, known as the primary care incentive program. Emergency physicians were not included in that new federal reimbursement incentive program despite the amount of primary care provided in the ED.
We cannot stress the importance of this campaign enough. Talk with your group’s practice management leadership to quantify what an additional 15% drop in payments for your Medicaid population would do to your practice’s sustainability, which represents 30% of visits for some groups and will likely go much higher for the reasons mentioned above.