• Physicians (not) accepting new patients with Medicaid

    Austin alerted me to some preliminary results from Jackson Healthcare’s Physician Practice Trends Survey:

    Currently, 36 percent of physician respondents reported being unable to accept new Medicaid patients. Twenty-six percent of physicians said they do not see Medicaid patients at all.

    Top five physician specialties least likely to accept new Medicaid patients:

    • Dermatologists (34 percent)
    • Endocrinologists (36 percent)
    • Plastic Surgeons (36 percent)
    • Internal Medicine: General (42 percent)
    • Physical Medicine & Rehabilitation (43 percent)

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

    • Pediatric Subspecialists (95 percent)
    • Pathologists (90 percent)
    • Radiologists (86 percent)
    • Anesthesiologists (83 percent)
    • General Surgeons (81 percent)

    Now those who want to panic will note that more than one third of physicians will not accept new Medicaid patients. Coupled with the fact that something like 16 million more people will have Medicaid under the ACA, and that looks like a recipe for disaster. But there are a few caveats you need to remember:

    1. Medicaid currently under-reimburses. If the ACA holds, though, reimbursement rates will look more like those seen in Medicare, which is much better.
    2. Medicaid is mostly a program for children and pregnant women. Therefore, it’s most important that pediatricians and Ob/Gyns not be on that denial list. They’re not. It’s less concerning if docs who don’t see many Medicaid beneficiaries don’t accept new ones.
    3. There are lots of docs who don’t accept new patients with private insurances. Networks by definition deny you acceptance if you don’t have the right private insurance. But you never see articles complaining that this is a reason to hate private insurance.

    Regardless, I don’t dispute the findings. But when docs won’t accept an insurance because it can’t pay enough, you fix it by figuring out a way to pay more. That requires more money, not cuts.


    • This whole topic puzzles me when it comes up in discussions. The fact that some docs are not taking Medicaid (or Medicare) leads some to think we should get rid of these two programs and have everyone on private insurance policies. Private insurers do pay much better fees for physicians, but how can we talk about bringing down health care costs while increasing fees by 20%-30%?


    • The problem with putting everyone on private insurance is that public health programs would lose the leverage to negotiiate lower prices that comes with the sheer volume of business they represent. Ideally, as taxpayers we want Medicare and Medicare to pay the least amount possible, while still paying enough to ensure adequete access to care for program beneficiaries. Private insurance attracts more providers because it pays more. Additionally, Medicare and Medicaid typically have lower administrative costs than private insurance. They do not have to pay for marketing campaigns, offer lucrative salaries and perks to attract top executive talent, or generate quarterly profits to please corporate shareholders. Obtaining services for Medicare and Medicaid beneficiaries through private insurance introduces another middleman into the process. We are lacking empirical evidence that demonstrates that using private insurance to procure services provides savings that offsets this addtional layer of administrative expense and bureaucracy.

    • My son is soon to graduate from med school with > $300,000 debt. He suggests that gov’t could help subsidize payback of loan payments with a lower interest rate in return for seeing Medicaid patients. It’s an idea.

      • I too am graduating from medical school in a couple months with the same amt of student loan debt as your son. It’s definitely an idea!

    • Massachusetts has taken the reverse “hardball” approach. Instead of offering incentives to treat Medicare/Medicaid patients, they are using a punitive, stick-only approach.

      There’s a bill in progress in Mass that would require all doctors AS A CONDITION OF LICENSURE, to treat Medicare/Medicaid patients. In other words, you cant practice medicine in that state unless you agree to accept those patients.

      Massachusetts already has more doctors per capita than every other state in the country, so when the doctors start moving elsewhere it shouldnt hurt them too much.

    • @docjones

      “…so when the doctors start moving elsewhere it shouldnt hurt them too much.”

      To whom does “them” refer in the previous phrase?
      — If you mean the doctors, we weren’t really worried about them.
      — If you mean those of us who live in Massachusetts… especially those of us whose healthcare spending is going to be cut 33% by RomneyCare 2.0 price controls… this is not good news

    • I thought that the goal of Medicaid expansion was to expand it beyond covering only women with children to all meeting the FPL criteria. Therefore, more new patients of all ages needing all kinds of primary and specialty care will be covered under the ACA Medicaid expansion.
      Do I have it wrong about who the ACA Medicaid expansion will cover?

    • Why don’t people try getting better jobs so they don’t have to use Medicaid?
      Beggars can’t be choosers.

      • Because employers at those better jobs won’t be able to offer private insurance (or full time employment) for much longer, given the dramatic increase in price and regulations that penalize them for doing so.