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Medicaid payment bump raised amount of available pediatric appointments
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After Medicaid payments were raised to Medicare levels by the Patient Protection and Affordable Care Act, more primary care pediatricians were able to attend appointments for Medicaid-insured children, according to a study published in Pediatrics.
“The Patient Protection and Affordable Care Act intended that the higher payments would stimulate additional primary care physician participation in the Medicaid program in anticipation of a concurrent expansion of Medicaid eligibility,” Suk-fong S. Tang, PhD, from the AAP, and colleagues wrote. “Whether this transient payment increase succeeded in encouraging physician participation in the Medicaid program remains an important and unanswered question amid conflicting evidence.”
To examine the changes in Medicaid participation before and after this increase on a state and national level by office-based primary care pediatricians, the researchers conducted a bivariate statistical analysis to assess the relationship between data gathered from 2011-2012 and 2015-2016. All data were collected from state-stratified random samples of pediatricians by the AAP.
Of the 10,395 pediatricians included in the study from 27 states, participation in Medicaid increased by four out of five indicators on a national level between 2011-2012 and 2015-2016. Practices accepting some new patients insured through Medicaid increased to 77.4% by 3.0 percentage points, whereas those taking all new patients rose by 5.9 percentage points to 43.3%. Practices that accepted a similar number of Medicaid-insured patients and privately insured patients increased by 5.7 percentage points to 55.6%.
When analyzing provider panels, the number of Medicaid-insured patients increased to 3.13% by 6.0 percentage points, and those labeled as nonparticipants decreased to 14.6%. When the researchers examined the geographic range of Medicaid use, 16 of the 27 states had an increased number of participants by one or more indicators, 11 by two or more indicators and three by all five.
“Importantly, we highlight in our results how nuances in participation measures can change measurement outcomes and potentially support different conclusions about the effects of payment increase on physician participation,” Tang and colleagues wrote. “For example, had we counted only those who accepted at least some new Medicaid patients, we would have observed that participation remained unaffected in Alabama and New Jersey, despite sizable gains made by these two states on most other indicators.
“In fact, using this single measure, we would have captured participation gains in only four states and missed eight others as identified by the nonparticipant, the full participant and the nonrestrictive participant indicators,” the researchers continued. “Although a thorough discussion of the merits and weaknesses of the respective measures is beyond the scope of this study, our results suggest that for policy evaluation, the choice of indicators vis-à-vis the policy goal would be at least as important as the measurement outcome.” – by Katherine Bortz
Disclosures: The authors report no relevant financial disclosures.
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