May 6, Wisconsin Health News

Emergency physicians would see their first boost in Medicaid rates in more than two decades under a proposal in Gov. Tony Evers’ next biennial budget. 

Wisconsin pays less than any other state for emergency medicine evaluation and management, the Medicaid code that emergency physicians submit for more than 90 percent of the care they provide, said Dr. Lisa Maurer, legislative committee chair of the Wisconsin Chapter, American College of Emergency Physicians. 

Emergency doctors last saw an increase in Medicaid rates in 1994, she said. More hospitals now contract out clinical services for providers working in the emergency department, with around half of emergency department physicians part of a separate practice group.

On top of that, emergency physicians are federally mandated to see anyone who has an emergency, which differs from other doctors in other specialties like primary care who can manage their patient payment mixes to make their practice viable, Maurer said. 

Current Medicaid reimbursement doesn't cover the cost of providing that care, paying 40 cents on the dollar for the care provided, she said.  

“It really puts the practice groups and the hospitals that employ their physicians for that matter in a tough spot,” Maurer said. 

The state has an “amazing network” of emergency physicians, but it’ll be hard to retain that unless there’s a significant increase in the Medicaid reimbursement rate, she said. 

Evers' 2021-23 budget would boost the rate to around 70 cents on the dollar, Maurer said.

“It’s a big increase,” she said. “The timing couldn’t be better.” 

Mark Grapentine, chief policy and advocacy officer at the Wisconsin Medical Society, said that Wisconsin's emergency physician reimbursements for common Medicaid services lag behind all neighboring states.

"Because many emergency physicians are organized as independent groups so that they can contract with hospitals from multiple systems, Medicaid reimbursement rates that don’t come close to paying the basic cost of providing care threaten the viability of these independent entities," he said.

Per the Legislative Fiscal Bureau, the budget would provide $10.4 million in state and federal funds to temporarily increase reimbursement rates in calendar year 2022. 

That would set the rate at 50 percent of the rate paid by Medicare, boosting payments for physician services for emergency room visits by about 36 percent in aggregate that year. 

Department of Administration Secretary Joel Brennan told legislators last month in a letter requesting budget modifications that the provision was intended to provide a permanent and ongoing rate increase.

To do that, he asked for an increase in the appropriation of $5.2 million, which breaks down to $2 million in state funds and $3.2 million in federal money, to cover through June 30, 2023, when the two-year state budget ends. 

“We are over the moon that we are even being considered for an increase,” Maurer said. 

Joint Finance Committee Co-Chair Rep. Mark Born, R-Beaver Dam, said during a legislative panel on Doctor Day on Wednesday that “no final decisions” have been made, given that Assembly Republicans have to determine their positions and negotiate with senators. 

“I think it’s something that we should do something on," he said. "I also think EMS is an area that I would like to see some rate increases, but we haven’t had a caucus discussion on either one of those yet.”