Medicare acceptance rates on a downturn, and primary care physicians lead the way

December 13, 2012

Primary care physicians (PCPs) accept fewer Medicare and Medicaid patients than specialists, reveals a new report, which also predicts an overall decline in acceptance rates of government insurance programs across the nation once the Affordable Care Act (ACA) is fully implemented.

Primary care physicians (PCPs) accept fewer Medicare and Medicaid patients than specialists, reveals a new report, which also predicts an overall decline in acceptance rates of government insurance programs across the nation once the Affordable Care Act (ACA) is fully implemented.

Healthcare research company SK&A’s new study, “Physician Office Acceptance of Government Insurance Programs,” reports that that 83.6% of U.S. medical offices accept Medicare and 67% accept Medicaid overall. But that situation could change soon, the report states, citing recent industry forecast that seem to predict a decline in participation with programs such as Medicare among healthcare providers.

The ACA is expected to add health coverage for about 30 million Americans, and PricewaterhouseCoopers estimates that one-third of them will be on Medicaid, according to the report. Additionally, the 2011 National Ambulatory Medical Care Survey, cited in the report, predicts that 31% of office-based physicians say they will not accept new Medicaid patients.

“The findings of this survey are a valuable industry benchmark for the changes that we’re seeing in healthcare,” says Dave Escalante, senior vice president of OneKey and marketing at Cegedim Relationship Management. SK&A is a Cegedim company. “As the healthcare industry prepares to bring on more insured patients, doctors’ acceptance of government insurance programs appears to be trending downward.”

The report polled nearly 300,000 physician medical offices about their acceptance of government-funded programs and found that that acceptance appears to be largely influenced by the size and ownership of the practice. Larger, affiliated practices reported higher acceptance rates, whereas smaller, independent practices had lower rates.

Practices with higher patient volumes also reported higher acceptance rates, according to the report. As far as ownership’s effect on acceptance rates, Medicare was accepted by 89.4% of practices owned by healthcare systems, 89.1% of hospital-owned practices, and 82.7% by non-hospital and non-healthcare-system-owned practices.

And although PCPs are on the low end of the spectrum in terms of Medicare and Medicaid acceptance, specialists with the highest Medicare acceptance rates perform dialysis (98.1%), vascular and interventional radiology (98%), and colon-rectal surgery (97.7%). Specialties with the lowest Medicare acceptance rates are pediatrics (28.8%), occupational medicine (27%), and holistic medicine (21.4%).

For Medicaid, dialysis (97.5%), critical care medicine (95%), and nephrology (93%) have the highest rates. The lowest acceptance rates for Medicaid come from bariatrics (24.5%), occupational medicine (14.7%), and holistic medicine (9.2%).