KFF: PCPs' acceptance of Medicaid patients varies
In 2008, the primary care physicians (PCPs) who served Medicaid beneficiaries most actively were also the most willing to accept new Medicaid patients, and they had substantial resources and capacity to serve low-income adults, according to an April report from the Kaiser Family Foundation (KFF).
“However, they also face capacity constraints to serve more of this population,” the Washington, D.C.-based nonprofit continued.
KFF analyzed data from the 2008 Center for Studying Health System Change (HSC) Health Tracking Physician Survey to assess and analyze which PCPs are most likely to respond to the changes under the Patient Protection & Affordable Care Act (PPACA) by serving additional Medicaid beneficiaries.
The study sample included 1,460 PCPs who were broken into four categories based on level of Medicaid participation, as measured by self-reported distribution of practice revenue and acceptance of new Medicaid patients:
“High-share Medicaid PCPs, who account for 19 percent of all PCPs, are most willing to see new Medicaid patients—the vast majority (84 percent) report accepting ‘all’ or ‘most’ new Medicaid patients,” the report stated.
“More than two-thirds (68 percent) of moderate-share Medicaid PCPs, who make up 29 percent of PCPs, also report accepting ‘all’ or ‘most’ new Medicaid patients. In contrast, just 20 percent of high-share Medicare PCPs, who account for 19 percent of PCPs, accept ‘all’ or ‘most’ new Medicaid patients; half accept none.”
The PCPs who were most willing to see new Medicaid patients tend to work in lower-income areas and are more likely to practice in hospital-based settings and community health centers. They are also more likely to work in practices owned in part by a hospital. Median household income is lower in the ZIP code areas where high- and moderate-share Medicaid PCPs practice than in areas where high-share Medicare PCPs practice, the report asserted.
According to the report, high-share Medicaid PCPs are much more likely to work in hospital-based offices and community health centers (38 percent), compared to moderate-share Medicaid PCPs (17 percent) and high-share Medicare PCPs (6 percent). About 30 percent of both high- and moderate-share Medicaid PCPs report that a hospital has an ownership interest in their practice versus 19 percent of high-share Medicare PCPs who report this arrangement, the report added.
The majority of PCPs most willing to accept new Medicaid patients use health IT for core patient care purposes. About three-quarters of high- and moderate-share Medicaid PCPs reported using all EMRs and having IT available for up-to-date decision support in their main practice, and about 60 percent use IT to access patient notes, medications and problem lists. These levels are as high as the levels among high-share Medicare PCPs.
Low- and no-share Medicaid PCPs appear to offer less promise of expanding primary care access in Medicaid, the research found. For example, eight in 10 low- and no-share Medicaid PCPs accept no new Medicaid patients. Ninety-three percent of these PCPs reported that 5 percent or less of their practice revenue is from Medicaid. “These PCPs also limit their participation in Medicare and private insurance—more than one-quarter (29 percent) accept no new Medicare patients and about one-quarter accept just “some” (15 percent) or no (9 percent) new privately insured patients.
“System-wide changes in the organization of primary care delivery could affect which PCPs are willing and have the capacity to serve more Medicaid beneficiaries,” the report concluded. “For example, given that PCPs with larger Medicaid practices now are more likely than others to be hospital-affiliated, the emerging trend toward hospital acquisition of primary care practices documented elsewhere could lead to more practices expanding their Medicaid service.
"The degree to which changes like this take hold beyond a few local markets, and the impact of such changes on Medicaid participation decisions, still remain uncertain and merit monitoring.”
“However, they also face capacity constraints to serve more of this population,” the Washington, D.C.-based nonprofit continued.
KFF analyzed data from the 2008 Center for Studying Health System Change (HSC) Health Tracking Physician Survey to assess and analyze which PCPs are most likely to respond to the changes under the Patient Protection & Affordable Care Act (PPACA) by serving additional Medicaid beneficiaries.
The study sample included 1,460 PCPs who were broken into four categories based on level of Medicaid participation, as measured by self-reported distribution of practice revenue and acceptance of new Medicaid patients:
- High-share Medicaid physicians: PCPs who reported that 26 percent or more of their practice revenue is from Medicaid.
- Moderate-share Medicaid physicians: PCPs who reported that 6 percent to 25 percent of their practice revenue is from Medicaid and that they accept at least some new Medicaid patients.
- High-share Medicare physicians: PCPs who reported that 26 percent or more of their practice revenue is from Medicare, they accept new Medicare patients and they get some of their practice revenue from Medicaid.
- Low- and no-share Medicaid physicians: PCPs who do not meet the criteria for either the high- or moderate-share Medicaid groups or the high-share Medicare PCP group.
“High-share Medicaid PCPs, who account for 19 percent of all PCPs, are most willing to see new Medicaid patients—the vast majority (84 percent) report accepting ‘all’ or ‘most’ new Medicaid patients,” the report stated.
“More than two-thirds (68 percent) of moderate-share Medicaid PCPs, who make up 29 percent of PCPs, also report accepting ‘all’ or ‘most’ new Medicaid patients. In contrast, just 20 percent of high-share Medicare PCPs, who account for 19 percent of PCPs, accept ‘all’ or ‘most’ new Medicaid patients; half accept none.”
The PCPs who were most willing to see new Medicaid patients tend to work in lower-income areas and are more likely to practice in hospital-based settings and community health centers. They are also more likely to work in practices owned in part by a hospital. Median household income is lower in the ZIP code areas where high- and moderate-share Medicaid PCPs practice than in areas where high-share Medicare PCPs practice, the report asserted.
According to the report, high-share Medicaid PCPs are much more likely to work in hospital-based offices and community health centers (38 percent), compared to moderate-share Medicaid PCPs (17 percent) and high-share Medicare PCPs (6 percent). About 30 percent of both high- and moderate-share Medicaid PCPs report that a hospital has an ownership interest in their practice versus 19 percent of high-share Medicare PCPs who report this arrangement, the report added.
The majority of PCPs most willing to accept new Medicaid patients use health IT for core patient care purposes. About three-quarters of high- and moderate-share Medicaid PCPs reported using all EMRs and having IT available for up-to-date decision support in their main practice, and about 60 percent use IT to access patient notes, medications and problem lists. These levels are as high as the levels among high-share Medicare PCPs.
Low- and no-share Medicaid PCPs appear to offer less promise of expanding primary care access in Medicaid, the research found. For example, eight in 10 low- and no-share Medicaid PCPs accept no new Medicaid patients. Ninety-three percent of these PCPs reported that 5 percent or less of their practice revenue is from Medicaid. “These PCPs also limit their participation in Medicare and private insurance—more than one-quarter (29 percent) accept no new Medicare patients and about one-quarter accept just “some” (15 percent) or no (9 percent) new privately insured patients.
“System-wide changes in the organization of primary care delivery could affect which PCPs are willing and have the capacity to serve more Medicaid beneficiaries,” the report concluded. “For example, given that PCPs with larger Medicaid practices now are more likely than others to be hospital-affiliated, the emerging trend toward hospital acquisition of primary care practices documented elsewhere could lead to more practices expanding their Medicaid service.
"The degree to which changes like this take hold beyond a few local markets, and the impact of such changes on Medicaid participation decisions, still remain uncertain and merit monitoring.”