Blog | Wednesday, August 8, 2012

QD: News Every Day--Doctors still wary of accepting Medicaid patients

Slightly more than two-thirds of physicians accept new Medicaid patients, reports a survey that establishes a baseline for whether better reimbursement provided under the Affordable Care Act might prompt more doctors to enroll recipients onto their patient panels.

Nationally, 69.4% of physicians accepted new Medicaid patients, compared to self-pay (91.7%), Medicare (83.0%) or privately insured patients (81.7%), reported a study that appeared in the August issue of Health Affairs.

While Medicaid reimbursement will equal Medicare reimbursement for the years 2013 and 2014, one internist spelled out why he's not changing his practice management habits.

Robert Maro Jr., MD, ACP Member, practices in Cherry Hill, NJ, the state with the lowest Medicaid acceptance rate among doctors (40.4%). He told Kaiser Health News why the Medicaid bump won't change his mind about not accepting new patients:

"Robert Maro Jr., a Cherry Hill internist, said he had not accepted new Medicaid patients for 15 years because of low pay. He said the state reimburses him only $23.50 for a basic office visit, less than half of what he gets from Medicare or private insurers.

"Maro said he treats Medicaid patients in the hospital and in nursing homes, but would lose money treating them in the office, where his administrative costs are higher.

"He said he would start seeing new Medicaid patients only if knew the pay hike under the health law would continue beyond 2014. Otherwise, he worries he would take on new patients only to see rates fall back to the old levels in 2015, and then he would be required legally and ethically to keep treating them."

An ACP survey tracks closely with the numbers reported in the Health Affairs study. In the survey, among 3,109 U.S. members (no students or associates) practicing entirely or primarily outpatient medicine who responded, 34.1% were no longer accepting Medicaid patients.

Other items of note in the Health Affairs report:
--Physicians in solo practice were 23.5 percentage points (34% relative difference) less likely to accept new Medicaid patients than physicians in offices with at least 10 other physicians;
--Primary care physicians were 7.3 percentage points (11%) less likely to accept new Medicaid patients;
--Physicians outside of Metropolitan Statistical Areas were 12.9 percentage points (19%) more likely than others to accept new Medicaid patients;
--Physicians in the Midwest were 8.2 percentage points (12%) more likely than those in the Northeast to accept new Medicaid patients; and
--Physicians practicing in counties where at least 15% of the population was under the federal poverty level were more likely by about 8.4 percentage points (12%) than others to accept new Medicaid patients.