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Medicaid Patients Increasingly Concentrated Among Physicians
Proportion of U.S. Physicians Accepting Medicaid Patients Down Slightly over Past Decade
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In 2004-05, 14.6 percent of physicians reported receiving no Medicaid revenue, up from 12.9 percent in 1996-97, the study found. And about one-fifth of physicians (21 percent) reported accepting no new Medicaid patients in 2004-05a rate six times higher than for Medicare patients and five times higher than for privately insured patients.
Care of Medicaid patients also is becoming increasingly concentrated among physicians who practice in large groups, hospitals, academic medical centers and community health centers as fewer small practices accept new Medicaid patients. For example, 35.3 percent of physicians in solo and two-physician practices were not accepting new Medicaid patients in 2004-05, up from 29 percent in 1996-97.
"It isnt clear whether the increasing concentration is harmful to Medicaid patients access to care, since many large Medicaid providers are in areas where enrollees tend to live, such as inner cities and medically underserved areas," said Peter J. Cunningham, Ph.D., a senior fellow at HSC, a nonpartisan policy research organization funded principally by The Robert Wood Johnson Foundation.
"But, if large Medicaid providers face increased financial pressures and rising patient demand, quality of care and access to some services could be negatively affected," said Cunningham, coauthor of the study with former HSC Health Research Analyst Jessica H. May.
Previous research by The Urban Institute and HSC found that Medicaid payment rates increased modestly relative to Medicare rates between 1998 and 2003, despite some states reducing or freezing payment rates in the early 2000s because of severe budget pressures and rising Medicaid costs. According to the Centers for Medicare and Medicaid Services, Medicaid enrollment increased substantially during this period8 percent overall between 2000 and 2003.
Among physicians accepting no new Medicaid patients in 2004-05, about five out of six (84%) cited inadequate reimbursement as a moderate or very important reason for not accepting new patients, according to the HSC study. Billing requirements and paper work were cited by 70 percent of physicians as reasons for not accepting new patients, while about two-thirds cited delayed reimbursement. A smaller percentage of physicians cited concerns about having a full practice or the high clinical burden of Medicaid patients. Physicians in solo and small practices were more likely to cite these factors compared with physicians in larger and institutional practices.
"Relatively low payment rates and high administrative costs are likely contributing to decreased involvement with Medicaid among physicians in solo and small group practices," Cunningham said.
Based on HSCs nationally representative Community Tracking Study Physician Survey, the studys findings are detailed in a new HSC Tracking ReportMedicaid Patients Increasingly Concentrated Among Physiciansavailable here. The 1996-97 and 2000-01 surveys contain information on about 12,000 physicians, and the 2004-05 survey includes responses from more than 6,600 physicians. Response rates for the surveys range from 52 percent to 65 percent. Other key study findings include:
The Center for Studying Health System Change is a nonpartisan policy research organization committed to providing objective and timely research on the nations changing health system to help inform policy makers and contribute to better health care policy. HSC, based in Washington, D.C., is funded principally by The Robert Wood Johnson Foundation and is affiliated with Mathematica Policy Research, Inc.