Medicaid patient acceptance should rise with higher reimbursement, but capacity concerns persist

Higher reimbursement rates correlate with doctors' willingness to take on new Medicaid patients, according to a new study published this month in the journal Health Affairs. Nonetheless, 31 percent of surveyed physicians said they didn’t accept new Medicaid patients in 2011.

The research highlights the growing concern that despite having a higher percentage of the population insured in 2014 under provisions of the Affordable Care Act, the healthcare system as it exists today may not have the capacity to effectively handle the newly insured.

"Many factors unrelated to Medicaid policy levers affect the number of Medicaid patients seen by physicians who accept at least some Medicaid patients," said study author Sandra L. Decker, an economist with Hyattsville, Md.-based National Center for Health Statistics. "Yet the level of Medicaid physician payment has been shown to affect a physician’s willingness to accept any Medicaid patients."

Decker used data on office-based physicians from the 2011 National Ambulatory Medical Care Survey Electronic Medical Records Supplement to summarize the percentage of physicians currently accepting any new patients

She pointed out that limited access to doctors is one reason why so many more Medicaid patients rely on hospital emergency departments and outpatient facilities than do those with private insurance.

In all, roughly 96 percent of office-based physicians accepted new patients in 2011, compared with 69.4 percent who were willing to take on new Medicaid patients. Doctors working in a solo practice were 23.5 percentage points less likely to accept new Medicaid patients than those practices with 10 or more doctors.

Primary care physicians were 11 percent less likely and physicians outside of Metropolitan Statistical Areas were 19 percent more likely, respectively, than other doctors to accept new Medicaid patients.

While the likelihood of physicians to accept new Medicaid patients was not directly affected by the number of Medicaid enrollees in each state, it was affected by the ratio of Medicaid reimbursements to Medicare reimbursement rates. The study noted that an increase of 25.8 percent in the average reimbursement rate for Medicaid, which would effectively match the Medicare reimbursement rates, would increase the Medicaid acceptance rate from about 70 percent to 78.6 percent, or very close to the current acceptance rates of people who are newly insured in both Medicare (83.1 percent) and private plans (81.7 percent).

While this would seem to bode well for those who will be newly insured under any Medicaid expansion and for doctors as Medicaid reimbursements will be raised to match those of Medicare, Decker noted that it is hard to predict how the flood of new patients seeking care will affect the new patient acceptance rate.

“The number of people with healthcare coverage through Medicaid and the exchanges is expected to increase at the same time as Medicaid payment rates for primary care physicians are expected to increase in some states. This raises a question about the capacity of the healthcare workforce to meet this increased demand,” Decker wrote.

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