Getting Reform Right

Medicaid uncertainty

Meanwhile Medicaid, which is a much smaller business segment for providers than Medicare but whose beneficiaries tend to have more complicated medical needs, is barely a blip on the regulatory radar of survey respondents. Only 9% identified Medicaid as their biggest regulatory headache while just 5% identified it as requiring the highest long-term investment in human capital.

While only 4% of all respondents expect to stop taking Medicaid patients in the wake of PPACA, the numbers are higher among physician organizations: 13% will stop taking Medicaid patients and another 21% will reduce the volume. Still, half of physician organizations expect an increase in Medicaid patient volume.

"A lot of providers are looking at Medicaid as just continuing on as it is," says David C. Pate, MD, JD, president and CEO of St. Luke's Health System in Boise, Idaho. Indeed, 36% of all respondents expect no change at all in how their organization will handle Medicaid patients as a result of PPACA. But among physician organizations, just 16% expect the status quo.

Pate explains that when St. Luke's brings on a physician practice and makes it hospital based, "we insist that they see all patients regardless of their ability to pay." He adds that hospital-employed physicians and the hospital outpatient department are "picking up the slack" when the private physicians decide not to see Medicaid patients. "Otherwise it is going to be a tremendous burden, and costly for hospitals, when these patients don't have access and they end up in emergency rooms."

However, Pate cautions that a shortage of primary care physicians will be a challenge for every state that elects to expand Medicaid eligibility. He sees a move away from the physician-based care model to a team-based care model as helping to alleviate the situation. The team would manage a population of patients rather than having the physician see each individual patient.