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Nearly one-third of physicians do not accept 
new Medicaid patients, but incentives may help

Issue: October 2012

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Nearly one-third of physicians were unwilling to accept new Medicaid patients in 2011, but increasing Medicaid fees may provide an incentive for physicians to treat more of these patients in the future, according to a study recently published Health Affairs.

“Previous work by the Urban Institute in Washington, D.C. has found that payment rates to physicians for caring for Medicaid patients vary widely across states and that, on average, state Medicaid programs pay only about three-quarters of what Medicare pays physicians for the same services,” study author Sandra L. Decker, PhD, of the National Center for Health Statistics in Maryland, told Orthopedics Today. “This has always produced a concern that some office-based physicians may choose not to treat Medicaid patients because of low payment.”

Decker noted that the Patient Protection and Affordable Care Act calls for an increase in fees paid to primary care physicians who provide primary care services for Medicare patients in 2013 and 2014.

“This study provides baseline data that will be able to be compared to data in 2013 and 2014 to see whether and how much primary care physicians’ acceptance of new Medicaid patients increases in states that experience a considerable increase in payment rates,” she said.

Physician survey

Decker used data from the 2011 National Ambulatory Medical Care Survey Electronic Medical Records Supplement for the study. The survey had 4,326 physician respondents.

Decker found that 4% of physicians turned away new patients, 31% did not accept new patients on Medicaid and nearly 20% would not accept new patients on Medicare or private insurance. A higher number of physicians (60%) would not accept new Medicaid patients in New Jersey compared to 5% or less of doctors in Minnesota, Wyoming and North Dakota, Decker said.

Inequality of care

Other studies from the Medicaid and Children’s Health Insurance Program (CHIP) Payment and Access Commission noted that Medicaid patients do receive care, Decker said. Whether these patients can receive care at a physician’s office is the question, Decker said, with many patients turned away and relying on hospital outpatient and emergency departments or community health centers.

“It may be important in the future to assess whether quality of care is equal at these different sites and what the cost implications are,” she said. – by Renee Blisard Buddle

Disclosure: Decker has no relevant financial disclosures.