Primary Care Physician Willingness and Capacity to Treat More Medicaid Patients

Inadequate Access to Specialists and Time for Patient Care Constrain the Capacity of Primary Care Physicians Most Willing to Accept New Medicaid Patients

News Release
April 27, 2011

FURTHER INFORMATION, CONTACT:
Alwyn Cassil (202) 264-3484 or acassil@hschange.org

WASHINGTON, DC—Supporting increased capacity among primary care physicians already treating many Medicaid patients may be the best way to help ensure adequate capacity for people gaining Medicaid coverage under health reform coverage expansions starting in 2014, according to a national study by researchers at the Center for Studying Health System Change (HSC) and the Kaiser Family Foundation (KFF).

Primary care physicians (PCPs) who are the most willing to treat Medicaid patients already treat a high proportion of Medicaid patients, tend to practice in lower-income areas and have more practice resources to support care for Medicaid patients, including interpreters, non-physician staff for patient education and health information technology. But these same physicians are more likely to report problems finding specialists to treat their patients and inadequate time during patient visits, according to the study.

“Inadequate access to specialists is a major problem for primary care physicians who care for many Medicaid patients, and difficulty referring to specialists is an important reason behind some physicians’ unwillingness to treat Medicaid patients,” said HSC Senior Researcher Anna Sommers, Ph.D., coauthor of the study with Julia Paradise, M.S.P.H., an associate director of the Kaiser Commission on Medicaid and the Uninsured; and Carolyn Miller, M.A., an independent consultant.

Under federal health reform, Medicaid eligibility will expand to cover as many as 16 million more poor and low-income adults by 2019. Primary care physicians are much less willing to accept new Medicaid patients, compared with Medicare and privately insured patients. Given PCPs’ unwillingness to treat Medicaid patients, policy makers and others are concerned about adequate primary care capacity for new Medicaid patients. The law also increases Medicaid reimbursement rates for certain services provided by primary care physicians to 100 percent of Medicare rates in 2013 and 2014 but does not increase payments to specialists.

Based on HSC’s nationally representative 2008 Health Tracking Physician Survey, the study’s findings are detailed in a new KFF report—Physician Willingness and Resources to Serve More Medicaid Patients: Perspectives from Primary Care Physicians—available at www.kff.org/medicaid/8178.cfm. Funded by the Robert Wood Johnson Foundation, the survey includes responses from more than 4,700 physicians, and the response rate was 62 percent. The study sample was restricted to 1,460 physicians who identified their primary specialty as general internal medicine, family practice or general practice and who treat adults in outpatient settings.

While physicians most often cited inadequate reimbursement as the reason for not accepting Medicaid patients, the study found other factors, including delayed reimbursement and billing requirements, deter physicians. Follow-up interviews with 15 primary care physicians who took part in the survey indicated difficulty finding specialists to treat Medicaid patients was a major reason for not accepting Medicaid patients.

Surveyed PCPs were classified into four categories based on level of Medicaid participation, as measured by self-reported Medicaid practice revenue and acceptance of new Medicaid patients—high-share Medicaid physicians, moderate-share Medicaid physicians, high-share Medicare physicians, and low-and no-share Medicaid physicians.

Other key study findings include:

• Most high- and moderate-share Medicaid PCPs reported accepting new Medicaid patients. High-share Medicaid PCPs, who account for 19 percent of all PCPs, were most willing to see new Medicaid patients—the vast majority (84%) reported accepting all or most new Medicaid patients. More than two-thirds (68%) of moderate-share Medicaid PCPs, who make up 29 percent of PCPs, also reported accepting all or most new Medicaid patients. In contrast, just 20 percent of high-share Medicare PCPs, who account for 19 percent of PCPs, accepted all or most new Medicaid patients, and half accepted none.
• Inadequate access to specialists and time for patient care constrain the capacity of the PCPs most willing to accept new Medicaid patients.More than  a quarter (28%) of high-share and 18 percent of moderate-share Medicaid PCPs reported that lack of qualified specialists in the area is a major problem that limits their ability to provide high-quality care. About 40 percent of both groups reported inadequate time with patients as a major problem.
• The PCPs most willing to see new Medicaid patients worked in lower-income areas and were more likely to practice in hospital-based settings and community health centers, which are key sites of care for low-income people. They were also more likely to work in practices owned in part by a hospital.
• The majority of PCPs most willing to accept new Medicaid patients used health information technology (IT) for core patient care purposes. About three-quarters of high- and moderate-share Medicaid PCPs reported using all electronic medical records and having information technology (IT) available for up-to-date decision support in their main practice, and about 60 percent used IT to access patient notes, medications and problem lists.

The Center for Studying Health System Change is a nonpartisan policy research organization committed to providing objective and timely research on the nation’s changing health system to help inform policy makers and contribute to better health care policy. HSC, based in Washington, D.C., is funded in part by the Robert Wood Johnson Foundation and is affiliated with Mathematica Policy Research.