Affordable Care Act Giveth to—and Taketh Away from—Urgent Care Centers

William Rodney, MD couldn’t jump fast enough when he found out the Affordable Care Act (ACA, or “Obamacare”) would be raising Medicaid primary care payments to Medicare levels. His urgent care practice (featured here previously; see One Year In, Latino-focused Clinic Doubles in Size) took in enough additional fees to create an outreach clinic for bilingual uninsured patients and to provide x-rays, ultrasound, and other services for underserved communities in Tennessee. Now he’s worried about his cash flow drying up because state audits determined that he’s out of compliance with vague regulations that could also be irrelevant in rural areas. The problem is that CMS rules say Medicaid providers have to be board certified in internal medicine, family medicine, or pediatrics in order to qualify for the benefits. Rodney, like many physicians in rural areas, is not but the fact is that even many hospitals in those areas don’t require board certification. Doctors without board certification could still qualify as PCPs if 60% of the codes they submitted in their claims were for a select set of primary care E&M or vaccination services. If neither of those criteria apply, experienced physicians like Rodney are out of luck. Some are even being asked to return a portion of funds they received. While physician advocates are taking up the cause for Rodney and others, the concern among urgent care operators now is that other states will start following Tennessee’s example.