Determinants of Medicaid Participation by Physicians

Authors of this Health Affairs study explore two factors critical to physician participation in Medicaid – reimbursement rates and reimbursement delays. Prior studies have shown that Medicaid participation is better among physicians in states that reimburse with higher rates compared to states that reimburse with lower rates. This also factors into whether or not physicians are willing to add new Medicaid patients to their clinical schedules. While 84% of physicians cite Medicaid payment rates as critical to this decision, 70% complain about paperwork issues and 65% complain about payment delays.

 

Data from this study were derived from two sources: (1) the 2004-5 Community Tracking Survey, a telephone survey sampling physicians from 60 randomly selected communities and (2) the 2006 administrative records from AthenaHealth, Inc which processes physician payments. 

 

Results demonstrate large state-to-state variations in delays for Medicaid payments ranging from 37 days in Kansas to 115 days in Pennsylvania.  For commercial insurers, payment delays are much shorter, ranging from 22 days in Rhode Island to 55 days in Louisiana. As for the rates of Medicaid payments, some states such as North Carolina pay up to a full 100% of Medicare and others such as New York, New Jersey, and Rhode Island pay less than half of the Medicare rate.

 

In logistic regression analysis, it is clear that increasing Medicaid payment rates are positively correlated with the probability of having any Medicaid patients (80% in states with low rates vs. 90% in states with high rates) and the probability of accepting all new Medicaid patients (44% vs. 59%). This finding is significant for both primary care physicians and specialists; however, the magnitude of this effect is much larger for specialists. The effect of Medicaid payment delays only has a significant effect among specialists; those in states with slow reimbursement rates are significantly less likely to have any Medicaid patients compared to specialists in states with fast reimbursement (83% vs. 86%).

 

Commentary:

This study adds to the body to knowledge, and common sense thinking, that states which reimburse physicians more for Medicaid patients will see greater physician participation in the program. Delays in payments – while certainly disheartening for clinicians – do not have as great an effect on physician behavior as the actual rate of payment. These data provide further evidence that states should bring physician payments for Medicaid in line with Medicare rates in order to improve access to care for disadvantaged populations.

Health Affairs 2009; 28: w17–w28.

 

by

Cedric K. Dark, MD, MPH


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