New Rule Would Bring Medicaid Payments for Primary Care in Line with Medicare’s

Monday, May 14th, 2012
This post was written by Cheryl Miller

Under a proposed rule, Medicaid will reimburse primary care services for family medicine, general internal medicine, pediatric medicine and related sub-specialists at Medicare levels in 2013 and 2014. Such a ruling could help encourage primary care physicians to continue and expand their services to Medicaid beneficiaries, including providing checkups, preventive screenings, vaccines and other care, CMS officials say.

CMS follows the AMA’s recommendations when calculating physicians’ fees under Medicare nearly 90 percent of the time, a report from Columbia University finds. The fees, which are based on assessments of time and effort associated with various physician services, often influence how some state and private payors pay doctors. In recent years there have been increasing pay gaps between PCPs and specialists, and PCPS have expressed concerns that the AMA committee is partly responsible for this. More in this issue.

The problem of obesity continues to grow, with the latest findings estimating that nearly half of the U.S. population could be obese by 2030, which means the healthcare system could be burdened with 32 million more obese people by that time, according to research from Duke University, RTI International, and the CDC. Keeping obesity rates level could save nearly $550 billion in medical expenditures over the next two decades, researchers state.

And the age of claimants for critical illness insurance policies decreased in the past year, according to a study from the American Association for Critical Illness Insurance. The majority of claimants were younger than 55, marking a significant increase in claims by younger policyholders compared to those filed in 2010.

Don’t forget to participate in our second annual survey on ACOs. If you contribute by May 16th, you will get a FREE executive summary of the compiled results and year-over-year ACO trends.

These stories and more in this week’s issue of the Healthcare Business Weekly Update.

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