Nearly Half of Primary Care Doctors Unaware of ACA Pay Hikes

Robert Lowes

June 23, 2015

Five years after Congress passed the Affordable Care Act (ACA), almost half of primary care physicians are in the dark about pay raises the law bestowed on them, according to a new survey of these practitioners.

That survey, conducted earlier this year by the Kaiser Family Foundation (KFF) and the Commonwealth Fund, also reported that 48% of primary care physicians said they did not know enough about the law to understand how it was affecting their practices.

One ACA provision raised their Medicare rates for office visits and preventive care by 10% from 2011 through the end of 2015. Yet 49% of physicians surveyed said they were unaware of this increase.

Another part of the law increased Medicaid rates for office visits and vaccine administration to Medicare levels in 2013 and 2014 for primary care physicians. Roughly one third of the states are using their own money to preserve all or part of this Medicaid raise in 2015.

The survey found that 47% of primary care physicians did not know about the so-called Medicaid payment bump. Of those in the know who had received the bonus, 22% said it made a big difference in motivating them to see more Medicaid patients, and another 30% said it made a small difference.

In another test of ACA knowledge, 41% of primary care physicians incorrectly answered the question of whether their state expanded its Medicaid program, or else said they did not know. Physicians were more likely to be misinformed or uninformed if their state had failed to expand its Medicaid program.

Reaction From Organized Medicine

Robert Wergin, MD, president of the American Academy of Family Physicians (AAFP), said he was "almost shocked" by survey results revealing widespread ignorance of how the ACA increased reimbursement for primary care physicians.

"We try to keep our members informed," Dr Wergin told Medscape Medical News. He noted that his association's online newsletter, AAFP News, has published more than 1500 articles on the healthcare reform law.

The AAFP has made primary care pay under the ACA a high-profile issue, Dr Wergin said. It has urged members to contact their elected representatives in Congress and lobby for continued federal funding of the Medicaid pay bump. Likewise, the AAFP wants the 10% raise in Medicare reimbursement made permanent.

An executive at the American College of Physicians (ACP) also is scratching his head over the survey results.

"It's impossible to say for sure why physicians didn't have more awareness of the two primary care payment incentive payments and the Medicaid expansion," said Robert Doherty, the ACP's senior president of governmental affairs and public policy. "I know that it isn't for lack of ACP — and I expect other primary care related societies — informing them about the programs."

That said, Doherty speculated that many physicians were too busy with patient care and business affairs to keep up with the ACA's reimbursement policies. "Many leave payment issues to their office staff and practice managers to deal with," he told Medscape Medical News.

He added that many primary care physicians probably do not associate their Medicare reimbursement with the ACA, much less understand it, given the complicated formula for setting it. The Medicaid pay bump, Doherty said, might not have appeared on the radar screens of physicians simply because it was in effect for only 2 years. Plus, physicians had to attest to their state Medicaid programs that they were eligible for the raise, a requirement that they may not have known about.

Partisan Lens Is Hard to Discard, Says ACP Leader

The survey by the KFF and the Commonwealth Fund, a health policy think tank, also found that 52% of primary care physicians harbored an unfavorable view of the ACA, whereas 48% liked it. Opinions strongly correlated to party affiliation: 87% of Republican physicians opposed the law, and an equal percentage of Democrat physicians were supporters.

The AAFP's Dr Wergin said that greater awareness of the primary care pay hikes in the ACA might have won over more physicians. Robert Doherty at the ACP agreed, but said the increase would have been only minor.

"The survey showed that Republican-leaning doctors disapprove of the ACA, and I doubt there is anything that would change their minds," he said. "Doctors are like the rest of the public, viewing the ACA through a partisan lens that isn't particularly malleable to data to change their impressions."

The survey is available on the KFF website.

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