Policy & Regulation News

Does ACA Boost Physicians’ Medicaid Participation?

By Jacqueline DiChiara

- Medicaid beneficiaries are keeping the doctor away.

Newly released data may offer a fresh industry-wide perspective about how often physicians accept Medicaid regarding delayed implementation stemming from the Affordable Care Act’s (ACA’s) objective to boost physician participation.

There is a notable preference from physicians to accept patients with Medicare or private insurance over Medicaid beneficiaries, according to recently released survey results involving over four thousand physicians from the National Center for Health Statistics (NCHS).

Almost one-third of office-based physicians refused to accept new Medicaid patients from February to June in 2013, confirm Esther Hing, MPH, from the Centers for Disease Control and Prevention’s National Center for Health Statistics, et al.

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  • According to the NCHS data brief, physicians accepted fewer Medicaid patients than Medicare patients or privately insured patients. In 2013, ninety-five percent of most office-based physicians accepted new patients. Additionally, almost sixty-nine percent of physicians accepted new Medicaid patients throughout 2013. Over eighty-four percent of physicians accepted privately insured patients.

    There is a noteworthy distinction in Medicare beneficiary acceptance by office-based physicians according to state and geographic region, state Hing, et al. The range of acceptance reported varied from seventy-five percent in Hawaii to ninety-five percent in North Dakota. In some states, such as Massachusetts and Vermont, there were almost double as many office-based primary care physicians than those in states such as Georgia and Texas.

    Additionally, physicians were more likely to accept new Medicare beneficiaries compared to the national average of eighty-three percent in Minnesota, Nebraska, New Hampshire, North Dakota, Pennsylvania, South Dakota, and Wyoming, confirm Hing, et al.

    Similarly, office-based physicians reportedly accepted Medicaid patients in markedly different quantities. The range of such varied substantially, from thirty-eight percent in New Jersey to ninety-six percent in Nebraska. The lowest percentage of physicians accepting new Medicaid patients was reported within California, Florida, Louisiana, New Jersey, and New York.

    Numerous 2013 and 2014 provisions of the ACA stressed Medicaid payment rates for primary care physicians’ primary care services match Medicare rates with full federal financing with Medicaid payments for some services equaling Medicare rates. Many states, therefore, experienced delays in the implementation of payment increases, concludes Hing, et al.

    Many states failed to implement payment increases because of such delay, according to Stephen Zuckerman and Dana Goin from The Urban Institute. Matching Medicaid primary care fees with Medicare fees requires financing a fee increase with the aid of federal dollars.

    NCHS researchers confirm their collected data may lack accuracy. Such data was collected prior to most states implementing an ACA regulation requiring primary care physicians reimbursed at Medicare rates when administering certain primary care services to Medicaid beneficiaries. Researchers additionally suggest new surveys require completion to determine if physician acceptance of new Medicaid beneficiaries increased due to higher rates.

    The numbers are certainly valuable for more thorough understanding elsewhere.

    “State data on changes in physician participation and primary care use will be of keen interest as decision-makers evaluate the fee increase and consider policy beyond 2014.” confirm Zuckerman and Goin in a supplemental policy brief released by the Henry J. Kaiser Family Foundation.

    An increase in Medicaid physician fees for primary care intends to expand physician participation in Medicaid to address a growing demand for primary care as Medicaid enrollment continues to increase, confirm Zuckerman and Goin.

    As the healthcare industry at large collectively shifts in a value-based state of mind, especially awaiting the next step regarding SGR repeal and ICD-10 implementation this October, policymakers may consider such evidence as they evaluate Medicaid fees to actively advance and improve overall quality of care.