Physician Participation in Government Health Plans

An ongoing concern in government-sponsored health coverage programs, like Medicaid and Medicare is that the only way spending is kept under any kind of control is by continually reducing the compensation to providers.  At some point, it simply becomes untenable for many providers to accept low reimbursements, which inevitably leads to access issues for the beneficiaries of the programs.  A study in Health Affairs demonstrates what a significant issue this already is for the Medicaid program.   (HA Article)   The research was based on the 2011 National Ambulatory Medical Care Survey and found that while 96% of physicians are accepting new patients, 31% would not take new Medicaid beneficiaries, 17% would not take more Medicare members and a surprising 18% did not want new privately-insured patients.  Characteristics that led to less willingness to take new Medicaid patients included practicing in a metropolitan area or solo or in a small doctor group.

The percent of doctors taking new Medicaid patients varies greatly by state, with New Jersey the low at 40% and California next at 57%.  Primary care physicians are also slightly less likely than specialists to be willing to accept additional patients.  Since the reform act is intended to greatly increase Medicaid enrollment, it seems that many patients may have difficulty finding a doctor willing to treat them, likely leading to more emergency room and urgent care facility use.  The primary factor in determining acceptance rates may be the variation in payment rates, with states with higher fee schedules having more doctors who will take new patients.  The reform law may provide some temporary relief by increasing payment rates to 100% of Medicare in 2013 and 2014, but doctors are smart enough to know this won’t last, given the woeful condition of most states finances.  Unless and until real reform is initiated, the percent of doctors willing to go through the hassle of dealing with government program patients is likely to continue to decline sharply.