Physicians Far Less Likely to Take New Medicaid Patients, CDC Finds

The data confirm what Medicaid beneficiaries report and what a study by a Wharton School professor found: physicians' willingness to take on Medicaid patients is directly related to reimbursement rates.
Published Online: July 20, 2017
Mary Caffrey
Data released by CDC confirm reports heard from around the country: physicians are less likely to accept new patients covered by Medicaid. In this case, the data come from the doctors themselves.

A QuickStats update included in this week’s Morbidity and Mortality Weekly Report shows that overall, 88.9% of primary care physicians said they are accepting new patients, based on 2015 data from the National Electronic Health Records Survey. However, the survey found there are differences in acceptance rates based on the patient's expected form of payment:
  • 94.2% of physicians accepted patients with private insurance
  • 77.4% of physicians accepted patients with Medicare
  • 71.6% of physicians accepted patients with Medicaid
In 2015, the year the data were collected, CMS reported that Medicaid covered 70.5 million Americans. The sudden surge in Americans with Medicaid due to Affordable Care Act (ACA) had made it difficult for many to find a primary care doctor, in large part because reimbursements in the program had been historically low. A 2014 article in the New England Journal of Medicine said while there are several reasons why Medicaid beneficiaries have a hard time finding a primary care doctor, low or slow payments are the main ones.

To address this, the ACA included a temporary fee boost that expired at the end of 2014. In many states, fees returned to previous levels. The 2016 Kaiser Family Foundation Medicaid report found that enrollment was rising faster on a percentage basis than spending, both at the federal level and especially at the state level.

Daniel Polsky, PhD, MPP, an economist at the Wharton School at the University of Pennsylvania, ran an experiment in which field workers tried to get appointments, half posing as Medicaid recipients, and half posing as clients with private insurance. They did the experiment in 2012, before the ACA increased Medicaid payments and again in 2014, right after the pay boost took effect. The pay increase caused about an 8% increase in the number of people who could get appointments.

In an interview published by Wharton, Polsky said, “What was really compelling about our findings was there is great variation between states in terms of how much the pay increased, because Medicaid pays different amounts in different states.”

In states where payment increases doubled, the appointment rate jumped closer to 15%.

Reference

QuickStats. Percentage of office-based primary care physicians accepting new patients, by source of payment accepted—National Electronic Health Records Survey, 2015. MMWR. Morb Mortal Wkly Rep. 2017;66:766. DOI: http://dx.doi.org/10.15585/mmwr.mm6628a9

Compendia
Adult ADHD Compendium
COPD Compendium
Dermatology Compendium
Diabetes Compendium
GI Compendium
Immuno-oncology Compendium
Lipids Compendium
MACRA Compendium
Oncology Compendium
Pain Compendium
Rare Disease Compendium
Reimbursement Compendium
Rheumatoid Arthritis Compendium
Know Your News
HF Compendium
Managed Care PODCAST
$AD300x250BB$