[logged]Almost 1 in 3 Physicians Turn Away New Medicaid Patients
Robert Lowes
August 07, 2012
August 7, 2012 — Nearly a third of office-based physicians declined to accept new Medicaid patients last year, according to a new analysis of government survey data published in the August issue of Health Affairs.
Access to care proved substantially less difficult for new patients covered by Medicare and private insurance, who faced rejection rates of 17% and 18%, respectively.
Author Sandra Decker, PhD, an economist at the National Center for Health Statistics of the US Centers for Disease Control and Prevention, found that acceptance rates of new Medicaid patients varied widely on a state-by-state basis, with a low of 40.4% in New Jersey and a high of 99.3% in Wyoming. Acceptance rates generally were higher in states with higher Medicaid fee-for-services rates, expressed as a percentage of Medicare's rates in 2008. Medicaid rates in Wyoming in 2008, for example, were close to 150% of Medicare's — the nation's highest. Conversely, New Jersey's Medicaid rates were dead last, at 37% of Medicare. Nationwide, the average Medicaid-to-Medicare fee ratio is 74.2.
Source: National Center for Health Statistics at US Centers for Disease Control and Prevention
Dr. Decker writes that a Medicaid pay hike for primary care physicians under the Affordable Care Act (ACA) will persuade more of them to treat new Medicaid patients. The provision raises Medicaid rates to 100% of Medicare rates in 2013 and 2014 for evaluation and management services and immunization administration. However, the temporary nature of the raise might blunt its effect, she notes. Another unknown is whether there will be enough clinicians to handle the massive influx of patients who gain coverage under Medicaid and private insurance beginning in 2014 as a result of the ACA.
Self-Pay Patients the Most Popular
The willingness to welcome new Medicaid patients varied across a wide range of physician characteristics, according to the study. Physicians were more prone to keep the door open if they practiced in the Midwest or in rural areas, if they were in larger practices, and if they were younger than 45 years.
The acceptance rate for new Medicaid patients also was higher among specialists (71.7%) than primary care physicians (66.2%). The gap paled in comparison to that for new Medicare patients, who were accepted by 90.9% of specialists versus 71.4% of primary care physicians.
The most popular sort of patients in 2011 insured themselves. The acceptance rate for self-pay patients was 94.2% among specialists, 88.2% among primary care physicians, and 91.7% overall.
The author has disclosed no relevant financial relationships.[/logged]