Doctors just saying no to Medicare and Medicaid patients

Robin Wulffson MD's picture
Medicare, Medicaid, reimbursement
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According to the preliminary results of a new nationwide survey, many US physicians are refusing to care for Medicare and/or Medicaid patients. The medical staffing company Jackson Healthcare conducted the physician survey from April 19 through April 26 2012. They note that it has a margin of error of 2.1%.

The survey group comprised 2,232 physicians representing all specialties. Invitations were e-mailed to the physicians and the data was obtained online. Jackson Healthcare notes that this is the first of a multi-year survey to track physicians’ practice patterns in the era of healthcare reform.

The survey consisted focused on six topics:

  • Patient Capacity for Medical Practice
  • Access for Medicaid and Medicare Patients
  • Current Practice Environment
  • Accountable Care Organization/Medical Home Participation
  • Use of Nurse Practitioners and Physician Assistants
  • Current Retirement Plans

The survey found that 36% of physicians are not accepting new Medicaid patients and 26% see no Medicaid patients at all. Acceptance of Medicaid patients varied by specialty. The specialties least likely to accept Medicaid patients were:

  • Dermatologists (34%); dermatologists treat skin diseases, including skin cancer.
  • Endocrinologists (36%); endocrinologists treat problems with the endocrine system such as diabetes and thyroid disease.
  • Plastic Surgeons (36%); in addition to cosmetic procedures, some plastic surgeons devote part or all of their practice to reconstructive (i.e., burns or battlefield injuries).
  • Internal Medicine: General (42%).
  • Physical Medicine & Rehabilitation (43%); this specialty entails rehabilitation of a patient following events such as a stroke or injury.

Of note, cosmetic procedures are often not covered by healthcare insurance; thus, most patients undergoing a cosmetic procedure, regardless of type of insurance, pay for these procedures out-of-pocket.

Top five physician specialties most likely to accept new Medicaid patients were:

  • Pediatric Subspecialists (95%); pediatric subspecialties include neonatology (newborn care) and allergy.
  • Pathologists (90%); pathologists analyze laboratory tests such as pap smears and blood tests.
  • Radiologists (86%).
  • Anesthesiologists (83%).
  • General Surgeons (81%).

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Of note, physicians most likely to accept Medicaid are either hospital-based (i.e., anesthesiologists) or derive most patients through referrals from other physicians (i.e., general surgeons).

The number of Medicaid recipients is expected to escalate within the next decade. The Assistant Secretary for Planning and Evaluation (ASPE) is the principal advisor to the Secretary of the U.S. Department of Health and Human Services on policy development. In a recent policy brief, the ASPE estimated that between 13.4 million and 25.9 million new Medicaid enrollees will enter the U.S. healthcare system by 2020.

The situation for Medicare is less grim than Medicaid. Currently, 17% of all physician respondents reported that they did not accept new Medicare patients and 10% of physicians reported that they do not care for Medicare patients at all. The physician specialties least likely to accept new Medicare patients were:

  • Adult Psychiatrists (57%).
  • Plastic Surgeons (68%).
  • Internal Medicine (73%).
  • Family Practitioners (75%).
  • Obstetrics and Gynecology (76%).

The five physician specialties most likely to accept new Medicare patients were:

  • Cardiology (96%).
  • Hemotologists/Oncologists (96%); these specialists treat disorders of the blood and care for cancer patients.
  • Urologists (95%); these specialists treat kidney and bladder problems.
  • General Surgeons (92%).
  • Anesthesiologists and Neurologists (91% each).
  • Jackson Healthcare attributes the unwillingness of physicians to accept Medicaid and Medicare patients to reimbursement issues. Many physicians note that the reimbursement for Medicaid and Medicare patients results in a net loss. Although some physicians are financially well off and can make up the loss with other patients, others are not. The survey found that 36% of US physicians have minimal to no savings. Significant costs are incurred in running a medical practice. Professional liability (malpractice) insurance varies by specialty; however, it is a significant portion of the cost of a medical practice. In some specialties, the insurance premium versus practice revenue represents a smaller percentage. For example, neurosurgeons and obstetrician gynecologists both pay high premiums; however, the income of the average neurosurgeon is much higher than that of the average obstetrician/gynecologist. Office rent, office staff, and medical equipment also represent a significant portion of the cost of doing business.

    Jackson Healthcare plans to release a comprehensive summary of the survey findings in June 2012.

    Reference: Jackson Healthcare

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Comments

Not good. People are going to get sicker without medical care. I'm having a hard time finding primary care physicians for my own Medicaid patients. Some are having to travel further to see a physician. Luckily Medicaid provides transportation, but some refuse it because they have to sit and wait for so long to get back home. Not good at all.
The Affordable Care Act, President Obama's health-care overhaul passed by Congress last year, was designed to make it easier for Americans in situations like Verone's to get health insurance BTW check "Penny Health" for more information
The folks on Medicare better pray the Supreme Court or a possible Republican Administration voids ObamaCare, especially the hundreds of billions in Medicare cutbacks, oops I meant "savings" from the law.
Doctors are refusing medicare and medicaid because of money, and it's understandable. Medicare and medicaid reimbursements have been historically low, but they have been frozen at their current levels for the last 15 years, meaning that adjusted for inflation docs seeing medicare patients have seen a 40% pay cut from an already low reimbursement. Tuition at many public medical schools have increased on the order of 300% in the last 10 years alone! Malpractice insurance is going through the roof. Reimbursements need to be raised substantially, not the 10% bonus in Obamacare, that's a joke, it needs to be increased by 30-50% minimum to change anything. Keep playing it cheep, and we'll see more people on government insurance refused care.
Excellent points. If Medicare/Medicaid abuse(at all levels hospitals,:physicians, device manufacturers. patients, etc.) could be reduced, physician reimbursement could be increased.