Ways to Pump Up Your Bottom Line (Despite Healthcare Reform)

Leigh Page

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October 25, 2012

In This Article

3. Think Twice Before Taking on More Medicaid Patients

If the ACA were carried out as planned, it would offer some tantalizing short-term incentives to take on more Medicaid patients. State Medicaid programs typically shortchange doctors on reimbursements, but the new law increases Medicaid reimbursements for evaluation and management and immunization services to 100% in 2013 and 2014. To make sure that states can afford the Medicaid expansion, the federal government is providing 100% of the cost of the expanded services for the first 3 years, rather than the usual arrangement of sharing funding with the states.

However, the Supreme Court ruled in June that the ACA's Medicaid directives should be optional for each state. The governors of 5 states (Texas, Florida, Louisiana, South Carolina, and Mississippi) have said that they will opt out of the Medicaid expansion, and the governors of another 26 states say they are considering opting out. Before expanding your Medicaid practice, wait for your state to decide what it is going to do about Medicaid payments.

But even if your state accepts extra federal funding and raises reimbursements, Morgan says the payments could fall again 2 years later, and state Medicaid programs might simply go back to their old cheapskate behavior. "The fact that this federal commitment to increase Medicaid payments is only guaranteed temporarily may make some practices hesitate," she says. "It's an interesting situation."

The American College of Physicians reports that in 2008, Medicaid payments for primary care services were at 66% of Medicare rates. If you choose to take on more Medicaid patients, Orrick advises placing a strict limit on the number. "You may choose to do your fair share, which typically means that no more than 5% of your practice is Medicaid," he says. "This is a good defense, because other practices may decide they won't accept any Medicaid patients at all, and then everyone will come to you."

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