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Medicaid enrollees last in line when docs accepting new patients


Doctors are accepting new Medicaid patients at a far lower rate compared to new patients on Medicare or private insurance, according to a new study.

The study, released by the Medicaid and CHIP Payment and Access Commission (MACPAC) during its meeting Thursday, examined Medicaid rates by specialty, whether the physician is in a Medicaid expansion state and by managed care penetration status.

The study was based on an analysis of 2015 data from the National Ambulatory Medical Care Survey that asks if office-based physicians currently accept any new patients and whether they accept Medicaid as a payment source for the new patients.

Of the physicians that accept new patients, 70.8% accept new patients insured by Medicaid. That is a lower percentage than providers that accept Medicare at 85.3% and private insurance at 90%.

The survey also broke down the acceptance rate via the type of providers. General and family practice providers had an acceptance rate of 68.2% for Medicaid patients compared to 89.8% for Medicare and 91% for private insurance.

Only 35% of psychiatrists surveyed accepted new Medicaid patients but 62% accepted Medicare and private insurance.

Pediatricians had the highest rate of Medicaid patient acceptance at 78%.

The Affordable Care Act’s Medicaid expansion did not have a statistically significant impact overall on Medicaid acceptance rates. It also found that there was no difference in the overall provider rates between a state that did expand and another state that did not.

But there was a difference within specialties, namely obstetrician/gynecologists. In non-expansion states, obstetrician/gynecologists had an acceptance rate of 89.6% compared to a 73% rate in states expanded their Medicaid rolls, the study said.

Payment rates appeared to have a greater impact on Medicaid acceptance than whether a state expanded.

Physicians that resided in a state with a high Medicaid-to-Medicare fee index, where the Medicaid rate is close to the Medicare rate for the same service, had an 81% acceptance rate compared to a 64% rate in states with a low fee index.

Commission member and family physician Kisha Davis said that payment rates play a major factor into the decision among private practices to take Medicaid.

“The reason that our practice takes Medicaid is because in our state there is Medicare-Medicaid parity and that was a big financial business decision on whether or not we would take Medicaid,” said Davis, family physician at CHI Health Care in Maryland.

The survey also found a difference in acceptance rates based on whether the provider resided in a state with a high penetration rate for Medicaid managed care.

A physician in a state with a high managed care penetration rate had a Medicaid acceptance rate of 66.7%, compared to 78% for physicians in a state with a low penetration rate.

But payment rates likely were a factor in the acceptance rates, according to the data.

The study was done in conjunction with the University of Minnesota’s State Health Access Data Assistance Center. It was based on data from the 2015 National Ambulatory Medical Care Survey, which had responses from 1,410 office-based physicians across the country.