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Primary care physicians are less likely to accept new Medicaid patients than office-based physicians in general, according to a new analysis in Health Affairs. But primary care physicians' acceptance of new Medicaid patients varies widely by state.
Primary care physicians are less likely to accept new Medicaid patients than office-based physicians in general, according to a new analysis in Health Affairs.
Slightly more than 33% of primary care physicians weren't accepting new Medicaid patients in 2011 and 2012, compared with 30% of all office-based physicians. But primary care physicians' (PCPs') acceptance of new Medicaid patients varies widely by state, with only 9% of Minnesota PCPs not accepting new patients, compared with a high of 54% in New Jersey.
With denial rates ranging from 44% to 54%, PCPs in New Jersey, California, Alabama, and Missouri were far less likely than the national average to accept new Medicaid patients, according to the analysis, which was based on data from the National Ambulatory Medical Care Survey Electronic Medical Records Supplement in 2011 and 2012.
Along with Minnesota, there were several other states in which fewer than 20% of PCPs weren't accepting new Medicaid patients. These states include Wisconsin, Nebraska, Arkansas, West Virginia and Iowa.
Among PCPs, internists (44% non-acceptance) were the least likely to take on new Medicaid patients, while pediatricians (21%) were the most likely.
With a number of states choosing to move forward with Medicaid expansion under the Affordable Care Act (ACA), millions of new Medicaid patients could be seeking care from PCPs over the next several years. That's bringing the issue of new Medicaid patient acceptance by PCPs into sharper focus as questions remain around whether these new patients will have adequate access to care.
Under a provision of the ACA designed to increase PCP acceptance of Medicaid patients, PCPs will be paid higher Medicare reimbursement rates in 2013 and 2014 for some procedures involving Medicaid patients. The provision would increase Medicaid fees approximately 73%, but that number differs by procedure and by state, according to a study by the Kaiser Family Foundation.
Still, even though it's July 2013, PCPs in many states have not yet begun receiving the Medicaid payment boost, in some cases because there have been delays associated with certifying which physicians are eligible for the pay increase.
Prior evidence suggests that physicians’ acceptance of Medicaid patients may rise as Medicaid payment rates increase, according to the Health Affairs analysis. However, physicians' willingness to accept new Medicaid patients also depends on several other factors, such as delays in payment, the degree of administrative burden involved in getting paid, whether physicians are located in areas near where Medicaid beneficiaries live or work, and the possibility that Medicaid patients may be more likely than other patients to miss appointments.
For those reasons, it's "uncertain" whether the ACA's primary care Medicaid payment boost will achieve its desired results, the analysis says.
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