Anesthesia Billing Medicaid cuts anesthesia reimbursement
Author : Doc Clemens
The blog today is about how physician and therefore anesthesia reimburse is being cut for many state Medicaid programs. Fourteen states and the District of Columbia cut Medicaid physician pay for fiscal year 2011, down from 20 states in fiscal 2010. But continuing state budget deficits could lead to more new fee cuts than those already adopted for fiscal 2012, according to the Kaiser Family Foundation.The foundation's 11th annual survey of state Medicaid programs concluded that continued Medicaid budget pressure on many states led them to expand cost-saving measures in 2011 and 2012. These moves included increasing enrollment in Medicaid managed care, reducing or ending optional benefits such as dental care, tightening prescription drug formularies, and enacting or hiking co-payments, according to the Kaiser report, released on Oct. 27. However, reducing Medicaid fees to doctors and other health professionals was the most common cost-saving option enacted by states, according to the report. Twenty-two states adopted Medicaid physician fee cuts in fiscal 2011 or 2012, said Vernon K. Smith, PhD, report co-author and managing principal of Health Management Associates, a research and consulting firm.
In total, 39 states reduced Medicaid fees for physicians, hospitals or others caring for Medicaid enrollees in fiscal 2011. In fiscal 2012, 46 states adopted rate cuts, according to the report. Not all states cut Medicaid physician pay. Six states actually increased Medicaid doctor fees in fiscal 2011. Alaska raised rates for fiscal 2012. Also in fiscal 2011, 33 states were able to expand Medicaid eligibility, and 22 states did so for 2012. These expansions were possible in part because of funding from the 2009 federal stimulus package and the health system reform law.
1 state raised Medicaid fees in fiscal 2012, down from 6 in 2011.
Overall, state fee cuts outstripped the increases, Smith said. "The cuts tend to be broad and large, and the increases tend to be smaller and targeted." Also, reductions this year were about as likely to apply to primary care services as to specialists, Smith said. Previously, states had cut specialist pay before setting their sights on primary care.
The stimulus provided $103 billion in enhanced Medicaid funding from fiscal 2009 to 2011, Smith said. But those funds dried up this year, eliminating a source of federal revenue that had been used to plug budget holes. States are not eager to reduce Medicaid physician pay, Smith said. "Rate cuts are undertaken only because of the intensity of the fiscal pressure that states are under." Also, the threat of repeated Medicaid fee cuts raises concerns that enrollees will have more difficulty accessing needed care, he said.
The number of states reducing Medicaid pay for fiscal 2012 could exceed the 14 that already have adopted cuts if some states revisit their budgets, Smith said. Medicaid total spending projections grew by just 2.2% for fiscal 2012, while enrollment is expected to increase by 4.4%. "Almost two-thirds of the states said that the likelihood of a Medicaid shortfall in 2012 was at least 50-50," Smith said.
Medicaid enrollment in fiscal 2012 is expected to increase twice as much as spending.
Though state revenues have grown for 18 months straight, they are still at least 6% below their pre-recession levels, said Tracy Gordon, a fellow at the Brookings Institution's Economic Studies program.
State Medicaid spending already has increased dramatically, Smith said. The expiration of stimulus funding and continued high enrollment led to the single-largest increase in overall state Medicaid spending in the program's history: 28.7% for fiscal 2012.
Federal Medicaid funding could decline further. The Joint Select Committee on Deficit Reduction, which has until Nov. 23 to adopt at least $1.2 trillion in spending cuts, could consider a few major reductions that impact Medicaid. One could be limiting the extent of Medicaid provider taxes on physicians and hospitals. Typically, states count the taxes as local Medicaid funds, and then repay the taxed doctors and hospitals while using the additional federal matching dollars to maintain their programs. In his fiscal 2012 budget, President Obama said limiting these Medicaid provider taxes beginning in 2015 would save the government $18 billion.
States also must prepare to implement the health reform law's Medicaid expansion, which is expected to cover 16 million additional people beginning in 2014. "This is a huge challenge for states, particularly with the demand on their already-limited administrative resources," Smith said.