anna sommers † julia paradise ‡ carolyn miller * † center for studying health system change...

Anna Sommers †Julia Paradise ‡Carolyn Miller *

† Center for Studying Health System Change

‡ Kaiser Commission on Medicaid and the Uninsured

* Independent consultant

Presentation at State Health Research & Policy Interest Group Meeting, SeattleJune 11, 2011

Physician Willingness and Resources to See New Medicaid Patients:

Perspectives of Primary Care Physicians

Center for Studying Health System Change – www.hschange.org

ACA places new pressures on the Medicaid program


Extends Medicaid eligibility to most people up to 133% of FPL 16 million people will gain Medicaid coverage 25% increase over current enrollment

Raises Medicaid payment rates for primary care services delivered by primary care physicians to Medicare payment levels.

Temporary (2013 and 2014) Rates for specialty services remain unchanged.

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Study Objective

Describe willingness and resources of primary care physicians to accept new Medicaid patients.

For Medicaid policy, willingness to treat patients just as critical to understand as physician capacity.

First study to combine data on these two dimensions.

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Survey Data

2008 Center for Studying Health System Change (HSC) Health Tracking Physician Survey

Nationally representative sample of U.S. physicians

Self-administered mail survey

Provide direct patient care (20+ hrs per week)

62% response rate

More information:

Strouse et al. 2009, www.hschange.org

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Survey Data

Analytic sample

Primary care physicians (PCPs) based on self-report

internal medicine

family medicine

general practice

Excludes if practiced most hours on hospital staff or in ED

1,460 PCPs

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Methods PCPs ranked by level of participation in Medicaid

High-share Medicaid 26% or more of practice revenue from Medicaid

Moderate-share Medicaid 6-25% of practice revenue from Medicaid Accept new Medicaid patients

High-share Medicare (“Medicare”) 26% or more of practice revenue from Medicare Accept new Medicare patients Revenue from Medicaid 1% or more

Low and no-share Medicaid – none of the above

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In-depth Follow-up Interviews

15 PCPs were interviewed in Summer 2010, after the ACA became law:

(5) High-share Medicaid, (4) Moderate-share Medicaid, (6) High-share Medicare

Stratified by practice size, type, and region

Various markets represented (eg. low-income urban, small town, suburban middle-income).

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Low- and No- Share Medicaid

33.4%

High-ShareMedicare

19.0%

Moderate-Share Medicaid

29.1%

High-ShareMedicaid

18.5%

Figure 1Percent Distribution of Primary Care Physicians

by Level of Medicaid Participation, 2008

Note: Sample excludes pediatricians and physicians who work most hours on hospital staff or in emergency room.Source: 2008 HSC Health Tracking Physician Survey

High- and Moderate-

Share Medic-aid +

Medicare PCPs

66.6%

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8.3% **

20.1 % ** ‡

68.4 % **

83.6 %

11.3 %

29.0 % ** ‡

31.6 % **

10.8 %

80.4 % **

51.0 % ** ‡

5.6%

Low and No-Share

Medicaid

High-Share Medicare

Moderate-ShareMedicaid

High-ShareMedicaid

Figure 2. Acceptance of New Medicaid Patients by Physician's Level of Medicaid Participation,

Primary Care Physicians in 2008

All or most Some None

Difference from high-share Medicaid PCPs is statistically significant at *p<.05 and **p<.01. Difference from moderate-share Medicaid is statistically significant at †p<.05 and ‡p<.01.Source: 2008 HSC Health Tracking Physician Survey

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High-share Medicaid PCPs: More in hospital-based offices and community health

centers (38 vs 17 and 6%). High- and moderate-share Medicaid PCPs:

More report hospital ownership interest (30 vs 19%). Located in areas with lower household income.

Medicare PCPs (vs high/moderate Medicaid): More in solo/2-physician practices (44 vs 26 and 32%).

Practice Type and Location by Level of Medicaid Participation

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75.9%68.7%

27.8%

41.8%

78.1%

62.9%

17.6%**

41.4%

72.6%

44.9% **‡

11.5%**‡

32.7%*

All EMR Interpreter services

Lack of qualifiedspecialists in area

Inadequate time with patients

Figure 3. Resources and Constraints at Primary Care Physician's Main Practice

by Physician's Level of Medicaid Participation, 2008

High-Share Medicaid Moderate-Share Medicaid High-Share Medicare

Resources Constraints

Difference from high-share Medicaid PCPs is statistically significant at *p<.05 and **p<.01. Difference from moderate-share Medicaid is statistically significant at †p<.05 and ‡p<.01.Source: 2008 HSC Health Tracking Physician Survey

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PCPs currently limiting Medicaid panel expected to revisit participation level after Medicaid expansion.

Most cited at least one issue besides payment that would be considered. Difficulty finding specialists, paperwork, time-burden of

non-medical needs are all factors. Some consider Medicare patients/program to be more

of a burden than Medicaid. Illness burden of new patients

Findings of In-depth Interviews: Willingness

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PCPs most willing to accept new Medicaid patients are already serving many of them. Just as likely to use health IT, more likely to offer

other key supports. Practice in low-income areas. Report more constraints on time and difficulty

finding specialists. Supporting new capacity here might improve

access.

Summary and Discussion

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Moderate-share Medicaid PCPs hold some promise for adding capacity in Medicaid: Practice in lower-income areas, use health IT,

some have other supports in place. Decision matrix and makers may be different

because practice settings are different. Addressing issues other than payment

(payment delays, prior authorization) may increase participation levels.


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High-share Medicare PCPs hold less promise for increasing capacity: More are in solo/2-physician practices. Fewer have key patient supports. Location in higher-income areas may be a barrier.

Payment increases in Medicaid and trends in hospital acquisition of practices may impact both willingness and capacity.


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Kaiser Family Foundationhttp://www.kff.org/medicaid/8178.cfm

Jointly released inMedicare & Medicaid Research Review (MMRR)

Publication of the Centers for Medicare & Medicaid Services, Center for Strategic Planninghttps://www.cms.gov/MMRR/

Published study now available

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http://www.kff.org/medicaid/8178.cfm

anna sommers † julia paradise ‡ carolyn miller * † center for studying health system change...

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