Affordable Health Care Act may impact Medicaid and Medicare patients

2012-08-08 15:22
Affordable Care Act, Medicare, Medicaid, acceptance, reimbursement

According to a new survey, a number of physicians claim that they cannot afford to accept new Medicaid and Medicare patients when the Affordable Care Act is fully implemented.

It found that 96% of physicians accepted new patients in 2011; however, rates varied by payment source: 31% of physicians were unwilling to accept any new Medicaid patients; 17% would not accept new Medicare patients; and 18% of physicians would not accept new privately insured patients.

According to a new survey, a number of physicians claim that they cannot afford to accept new Medicaid and Medicare patients when the Affordable Care Act is fully implemented. The new analysis of government survey data was published in the August issue of the journal Health Affairs.

They survey accessed data on office-based physicians from the 2011 National Ambulatory Medical Care Survey Electronic Medical Records Supplement. It summarized the percentage of physicians currently accepting any new patients. It found that 96% of physicians accepted new patients in 2011; however, rates varied by payment source: 31% of physicians were unwilling to accept any new Medicaid patients; 17% would not accept new Medicare patients; and 18% of physicians would not accept new privately insured patients. It found that doctors in smaller practices and those in metropolitan areas were less likely than others to accept new Medicaid patients. Acceptance of new Medicare and Medicaid patients varied by state. Higher state Medicaid-to-Medicare fee ratios correlated with greater acceptance of new Medicaid patients.

Author Sandra Decker, PhD, an economist at the National Center for Health Statistics of the US Centers for Disease Control and Prevention (CDC) noted that the findings serve as a useful baseline from which to measure the anticipated impact of Affordable Care Act provisions that could increase Medicaid payment rates to primary care physicians in some states while boosting up the number of individuals with healthcare coverage. She reported a low acceptance rate of new Medicaid patients of 40.4% in New Jersey and a high of 99.3% in Wyoming. In general, acceptance rates generally were higher in states with higher Medicaid fee-for-services rates, expressed as a percentage of Medicare’s rates in 2008. For example, Medicaid rates in Wyoming in 2008 were close to 150% of the reimbursement for a Medicare patient; this marked the nation’s highest rate. In contrast, New Jersey's Medicaid rates were the nation’s lowest: 37% of Medicare. Nationwide, the average Medicaid-to-Medicare fee ratio is 74.2.

The acceptance rate for new Medicaid patients was higher among specialists (71.7%) than primary care physicians (66.2%). Acceptance was even higher for Medicare patients. Most specialists (09.0%) noted that they accepted new Medicare patients; 71.4% of primary care physicians. The most popular group of patients in 2011 was those that were self-insured. The acceptance rate for self-pay patients was 94.2% among specialists, 88.2% among primary care physicians, and 91.7% overall.

The top five states in which office-based physicians accepted new Medicaid patients in 2011:
Wyoming: 99.3%
Minnesota: 96.3%
North Dakota: 94.6%
South Dakota: 94.1%
Wisconsin: 93.0%

The bottom five states in which office-based physicians accepted new Medicaid patients in 2011:
New Jersey: 40.4%
California: 57.1%
Florida: 59.1%
Connecticut: 60.7%
Tennessee: 61.4%

The data was derived from the CDC’s National Center for Health Statistics.

Dr. Decker notes that a Medicaid pay increase for primary care physicians under the Affordable Care Act will influence more of them to accept new Medicaid patients. The provision raises Medicaid rates to 100% of Medicare rates in 2013 and 2014 for evaluation and management services and immunization administration. However, the temporary nature of the reimbursement rate might impact its effect. Another unknown factor is whether there will be enough healthcare professionals to absorb the massive influx of patients who gain coverage under Medicaid and private insurance beginning in 2014 as a result of the Affordable Care Act

Reference: Health Affairs

See also:
Healthcare costs predicted to soar in next decade
Doctors just saying no to Medicare and Medicaid patients

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