Medicaid payout low in N.J., Pa.

A doctor in New Jersey who sees a Medicaid patient for 15 minutes gets paid $20.60. The fee in Pennsylvania is $27.

Doing the same work for a Medicare patient pays $60 or more.

It would be no surprise then if area doctors shunned Medicaid patients in favor of those covered by Medicare.

That is what worries Public Citizen, a consumer-advocacy group. In a report released yesterday, it compared fees paid to primary-care physicians by Medicaid and Medicare. Medicaid rates are set by states and vary widely, while federal Medicare rates are more similar.

New Jersey and Pennsylvania landed in the bottom five states for Medicaid payments. In a comparison of 11 procedures, New Jersey's Medicaid payments were less than a third of Medicare's and Pennsylvania's were 42 percent less.

"There are a number of consequences," said Annette Ramirez de Arellano, a Public Citizen researcher who cowrote the study. "One is that a lot of practitioners decide it's not worth their while to see Medicaid patients." Others, she said, limit their Medicaid patients.

Ramirez de Arellano said the bottom-five Medicaid payers - Pennsylvania, New Jersey, New York, Rhode Island and the District of Columbia - tended to have broader eligibility rules and more generous benefits than those who paid the most: Alaska, Wyoming, Delaware and Arizona.

Physician leaders in Pennsylvania and New Jersey said the report was no surprise. Doctors have been complaining about this issue for years.

Mark Piasio, a Dubois orthopedic surgeon who is president of the Pennsylvania Medical Society, said the pay for a routine office visit was so low that "they're basically considered free visits."

A rural doctor who treats his neighbors, Piasio said he could not refuse to take Medicaid. "You just can't live in town if you don't take those patients," he said.

Stacey Witalec, a Pennsylvania Department of Welfare spokeswoman, said Medicaid raised rates for office visits in 2005 and is now figuring out how to target $3.6 million in new state funds for fee increases for fiscal 2007-08. Medicaid managed-care plans set their own payment rates. The state spends $5.1 billion on Medicaid.

The Welfare Department does not believe the state has an access problem because of its rates and is not concerned about the gap between its rates and Medicare's. "We do not consider this to be a major problem," she said.

Eileen Moynihan, a rheumatologist and former president of the Medical Society of New Jersey, said she treated Medicaid patients in the hospital but could not afford to treat them in her private practice in Woodbury. "It's really tough to even make ends meet normally," she said.

Gov. Corzine added $5 million to the $2.5 billion New Jersey spends on Medicaid this year to raise rates for pediatricians, said Suzanne Esterman, a spokeswoman for the state's Department of Human Services. There has been no raise for other physicians since "sometime in the '80s," she said.

Read Public Citizen's report on how much Medicaid doctors are paid at http://go.philly.com/medpayEndText