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A Wave of Medicaid Patients Is on the Way, but Who Will Treat It?

By Jane Norman, CQ HealthBeat Associate Editor

April 27, 2011-- As the health care law's expanded coverage of the uninsured brings 16 million more Americans into Medicaid by 2014, the challenge will be to find enough primary care physicians willing and able to treat those patients.

A study issued Wednesday by the Kaiser Family Foundation and the Center for Studying Health System Change says primary care physicians who now treat the highest share of Medicaid patients are willing to take on more of them.

But there are limits to what those doctors can do, and many more providers—including those who don't now see a lot of Medicaid patients—are going to be needed to meet the heightened Medicaid demand, the study says. The report was based on a health tracking survey of physicians and follow-up phone interviews.

A short-term payment boost for seeing Medicaid patients included in the health care law (PL 111-148, PL 111-152) may help, though payments are just part of the reason why some providers won't take Medicaid patients, the study says. More importantly, the difficulty in finding specialists who will accept referrals for Medicaid patients for further treatment is a barrier for care.

"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 a statement from authors Anna Sommers of the Center for Studying Health System Change; Julia Paradise of the Kaiser Commission on Medicaid and the Uninsured; and Carolyn Miller, a consultant.

The law expands eligibility for the federal-state Medicaid program to Americans younger than 65 and earning less than 133 percent of the federal poverty level. Experts predict a 25 percent increase in the number of Medicaid enrollees. Many will be very poor and are expected to arrive in physicians' offices with chronic conditions that have had little medical attention in the past.

The study looked at 1,460 physicians, including internists, family practice doctors and general practitioners. Those with high shares of Medicaid patients were defined as earning 26 percent or more of their revenue from the program, while those with moderate shares earned 6 percent to 26 percent of their revenue from Medicaid and accepted new patients. The remainder earned less than 6 percent or didn't see any Medicaid patients and were defined as low-share or no-share providers.

The high-share primary care providers most willing to see more Medicaid patients generally work in lower-income areas and are more likely to practice in hospitals or community health centers, the study says. Most use health information technology extensively. They often offer interpreter services for patients who don't speak English and provide patient education for those with chronic conditions.

But they report they don't have enough time as it is with each of their Medicaid patients. "Having inadequate time with patients may indicate that physician resources are strained, affecting the quality of care for all patients in the practice," the study says.

It also found looming problems in expanding access to care for people who will be joining Medicaid.

Eight out of 10 primary care providers who now have low or no shares of Medicaid patients accept no new Medicaid patients. They also limit their participation in Medicare and private insurance.

There may be a lack of "fit" in these doctors accepting more Medicaid patients because their offices are located in zip codes with higher median incomes compared to those who accept higher shares of Medicaid patients. They also don't have interpreter services or staff members who can provide patient education. And they are less advanced in their use of health IT.

Those doctors who now have moderate shares of Medicaid patients said they might revisit the issue as the health care law goes into effect, saying they might hire more nurse practitioners or other health care staff.

Low payment rates and administrative burdens like payment delays and billing requirements were often cited by doctors who don't accept many Medicaid patients.

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