Constraints to treating more Medicaid patients

Supporting increased capacity among primary care physicians already treating many Medicaid patients may be the best way to help ensure adequate capacity for people gaining Medicaid coverage under health reform coverage expansions starting in 2014, according to a national study by researchers at the Center for Studying Health System Change (HSC) and the Kaiser Family Foundation (KFF).

Primary care physicians (PCPs) who are the most willing to treat Medicaid patients already treat a high proportion of Medicaid patients, tend to practice in lower-income areas and have more practice resources to support care for Medicaid patients, including interpreters, non-physician staff for patient education and health information technology. But these same physicians are more likely to report problems finding specialists to treat their patients and inadequate time during patient visits, according to the study.

Physicians’ bottom line can be affected by their decision to participate in Medicaid when examining different managed care plans.

“There is one fee schedule determined by the state in the fee-for-service Medicaid program. When managed care plans contract with a state Medicaid program, the plan does not have to adhere to that schedule,” says Anna Sommers, the study’s lead author. “Physicians may prefer one managed care plan over another because plans will pay more or less for the same services and pay more or less promptly. Plans also have different billing and authorization procedures that are more or less of a burden. All of these factors can affect physicians’ bottom line as well as their willingness to participate in Medicaid.”

Under federal health reform, Medicaid eligibility will expand to cover as many as 16 million more poor and low-income adults by 2019. Primary care physicians are much less willing to accept new Medicaid patients, compared with Medicare and privately insured patients. The law also increases Medicaid reimbursement rates for certain services provided by primary care physicians to 100% of Medicare rates in 2013 and 2014 but does not increase payments to specialists.

Based on HSC’s 2008 Health Tracking Physician Survey, the study’s findings are detailed in a new KFF report: “Physician Willingness and Resources to Serve More Medicaid Patients: Perspectives from Primary Care Physicians.” Funded by the Robert Wood Johnson Foundation, the survey includes responses from more than 4,700 physicians, and the response rate was 62%. The study sample was restricted to 1,460 physicians who identified their primary specialty as general internal medicine, family practice or general practice and who treat adults in outpatient settings.