Looking Forward: 4 Boons Coming Your Way in 2014

Leigh Page


January 02, 2014

In This Article


The world has been changing rapidly for doctors. Some of the mandated changes evoke grumbles and discontent, but others spell positive developments for physicians -- or, if not quite positive yet, they will bring benefits as they continue to evolve and their initial problems get addressed.

Four of these developments are discussed below.

1. Extra Pay for Primary Care Physicians

Primary care physicians are reaping a variety of benefits from the Affordable Care Act, including a 10% bonus for primary care services from 2011 to 2015, fee increases from some commercial insurers, and new efforts to reimburse these physicians for their role as coordinators of patient care.

But perhaps the most dramatic change is a rise in Medicaid reimbursements for evaluation and management services and vaccinations in 2013 and 2014. The amount varies depending on the state, but Medicaid rates are expected to increase 73% on average nationwide for the targeted services.

Jaquelin S. Gotlieb, MD, a pediatrician in Stone Mountain, Georgia, says she is expecting roughly a 67% increase in the relevant Medicaid rates. "This will help tremendously financially," she said. The extra pay is especially important for pediatricians, because they are not eligible for Medicare increases and are more dependent on low-paying Medicaid reimbursements than other specialties. Dr. Gotlieb said 70% of her patients are on Medicaid.

Getting the money, however, has not been easy. As of early November 2013 -- 10 months after the payments were supposed to begin -- Dr. Gotlieb said she still had not received any of the payments. But she had just received word from Georgia Medicaid that the money would begin to arrive in the next 2 or 3 weeks. Delays across the country in paying the extra Medicaid funds were reportedly caused by problems with certifying eligible physicians and other bureaucratic snafus. As late as July 1, only a little more than one quarter of the states had started making the payments, according to the American Academy of Family Physicians (AAFP).

Although Dr. Gotlieb was happy about the extra pay, she did not believe it would make a big difference in changing physicians' attitudes toward Medicaid, noting that the payments will only last 2 years. She also doubted that the bonus would convince more medical students to choose primary care. She feels that her relatively low-paid specialty attracts "young idealistic people who don't really look at the issue [of payment]," she says.

Meanwhile, the impact of the Medicaid bonus payments was stifled by the refusal of 25 states, including Georgia, to accept federal funds to expand Medicaid coverage. Dr. Gotlieb said the states' refusal would have little effect on pediatrics, because most children are already included in Medicaid programs, but it would dramatically affect coverage of low-income adults, including the parents of many of her patients.

Because the extra Medicare and Medicaid payments are just temporary, primary care physicians should not get too used to them. Payers will continue to look to primary care physicians to coordinate patient care, but don't expect them to adequately reimburse for it.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.