HSC: PCP shortage looms as Medicaid enrollment rises
Growth in Medicaid enrollment under health reform will greatly outpace growth in the number of primary care physicians (PCPs) willing to treat new Medicaid patients, according to a study by the Center for Studying Health System Change (HSC).
Furthermore, temporary increases in Medicaid reimbursement meant to entice more PCPs into accepting Medicaid patients are unlikely to make much of a difference in the states facing the biggest enrollment jumps, the HSC analysis shows.
Under federal health reform, Medicaid eligibility will expand to cover as many as 16 million more low-income adults by 2019. Nationally, 42 percent of PCPs in 2008 were accepting all or most new Medicaid patients, whereas 61 percent of PCPs were accepting all or most new Medicare patients and 84 percent were accepting all or most privately insured patients, HSC stated. Given the unwillingness of many PCPs to treat new Medicaid patients, policymakers and others are concerned that primary care capacity may not be adequate to meet increased demands from new Medicaid patients, according to HSC, based in Washington, D.C.
States with the smallest number of PCPs per capita overall—generally in the South and mountainous West—potentially will see the largest percentage increases in Medicaid enrollment. In contrast, states with the largest number of PCPs per capita—primarily in the Northeast—will see more modest increases in Medicaid enrollment, the HSC study found.
Medicaid reimbursement increases will have much less impact in states with a relatively small number of PCPs accepting Medicaid patients now because many of these states already reimburse primary care at rates close to or exceeding 100 percent of Medicare, stated the study’s author, HSC Senior Fellow Peter J. Cunningham, PhD.
Geographic differences in PCP acceptance of new Medicaid patients reflect differences in overall PCP supply, not geographic differences in PCPs’ willingness to treat Medicaid patients, Cunningham wrote.
Using the Health Resources and Services Administration Area Resource File, the HSC study classified states into low-, medium- and high-PCP states based on the ratio of PCPs to the nonelderly U.S. population in 2008. In the HSC study, 25 percent of the U.S. population was in low-PCP states, 50 percent in medium-PCP states and 25 percent in high-PCP states.
PCP numbers also vary by state Medicaid program characteristics. Medicaid reimbursement rates for primary care, as a percentage of Medicare rates, are much higher on average in low-PCP states (81.6 percent) compared with high-PCP states (54.8 percent). States with fewer PCPs also tend to have more restrictive Medicaid eligibility.
Higher Medicaid reimbursement rates are associated with a greater probability of PCPs accepting all or most new Medicaid patients, although the effects are relatively modest, according to the study, which was sponsored by the Robert Wood Johnson Foundation.
“As increases in reimbursement rates alone cannot increase the supply of Medicaid PCPs to levels necessary for the likely growth in the Medicaid population, combining payment reforms with delivery system reforms will ultimately be essential to meet the long-term challenges of increased demand and limited supply,” concluded Cunningham.
Furthermore, temporary increases in Medicaid reimbursement meant to entice more PCPs into accepting Medicaid patients are unlikely to make much of a difference in the states facing the biggest enrollment jumps, the HSC analysis shows.
Under federal health reform, Medicaid eligibility will expand to cover as many as 16 million more low-income adults by 2019. Nationally, 42 percent of PCPs in 2008 were accepting all or most new Medicaid patients, whereas 61 percent of PCPs were accepting all or most new Medicare patients and 84 percent were accepting all or most privately insured patients, HSC stated. Given the unwillingness of many PCPs to treat new Medicaid patients, policymakers and others are concerned that primary care capacity may not be adequate to meet increased demands from new Medicaid patients, according to HSC, based in Washington, D.C.
States with the smallest number of PCPs per capita overall—generally in the South and mountainous West—potentially will see the largest percentage increases in Medicaid enrollment. In contrast, states with the largest number of PCPs per capita—primarily in the Northeast—will see more modest increases in Medicaid enrollment, the HSC study found.
Medicaid reimbursement increases will have much less impact in states with a relatively small number of PCPs accepting Medicaid patients now because many of these states already reimburse primary care at rates close to or exceeding 100 percent of Medicare, stated the study’s author, HSC Senior Fellow Peter J. Cunningham, PhD.
Geographic differences in PCP acceptance of new Medicaid patients reflect differences in overall PCP supply, not geographic differences in PCPs’ willingness to treat Medicaid patients, Cunningham wrote.
Using the Health Resources and Services Administration Area Resource File, the HSC study classified states into low-, medium- and high-PCP states based on the ratio of PCPs to the nonelderly U.S. population in 2008. In the HSC study, 25 percent of the U.S. population was in low-PCP states, 50 percent in medium-PCP states and 25 percent in high-PCP states.
PCP numbers also vary by state Medicaid program characteristics. Medicaid reimbursement rates for primary care, as a percentage of Medicare rates, are much higher on average in low-PCP states (81.6 percent) compared with high-PCP states (54.8 percent). States with fewer PCPs also tend to have more restrictive Medicaid eligibility.
Higher Medicaid reimbursement rates are associated with a greater probability of PCPs accepting all or most new Medicaid patients, although the effects are relatively modest, according to the study, which was sponsored by the Robert Wood Johnson Foundation.
“As increases in reimbursement rates alone cannot increase the supply of Medicaid PCPs to levels necessary for the likely growth in the Medicaid population, combining payment reforms with delivery system reforms will ultimately be essential to meet the long-term challenges of increased demand and limited supply,” concluded Cunningham.