Panel Paper: Acceptance of Medicaid Patients By Office-Based Physicians in 2011 and 2012

Thursday, November 7, 2013 : 11:50 AM
Salon III B (Ritz Carlton)

*Names in bold indicate Presenter

Sandra Decker, National Center for Health Statistics
This paper summarizes acceptance of new Medicaid across states and specialties in order to describe current use of and access to office-based physicians among Medicaid patients.   Access to office-based physicians has been shown to be important in helping Medicaid patients avoid relying on ambulatory care provided by hospitals, including care in emergency departments.  The study uses data from the National Ambulatory Medical Care Survey (NAMCS) Electronic Medical Records Supplement, conducted by the National Center for Health Statistics.  Acceptance of new patients with Medicaid in 2012 was compared across physician specialties and states.  Acceptance of new Medicaid patients in 2012 was also compared to 2011.  Finally, for combined 2011-2012 data, acceptance of new Medicaid patients was compared across states separately for physicians in primary care specialties (pediatrics and general/family and internal medicine) compared to other specialties.  Analyses used sample weights and standard errors accounted for the complex design of the survey. Two-tailed t-tests were used.  Statistical significance was assessed at p <0.05.

About 32.8 (95 percent confidence interval (CI) 30.6 – 35.1) percent of office-based physicians did not accept new Medicaid patients in 2012.   This is not significantly different compared to 2011.  The percent of physicians not accepting new Medicaid patients in 2012 was higher than the average across specialties for physicians in psychiatry (60.3, CI 50.7 – 69.9) and internal medicine (47.9, CI 41.2 – 54.4).  The percent of physicians not accepting new Medicaid patients in 2012 was statistically significantly higher than the national average in five states:  California (54.9, CI 43.4 – 66.5), Florida (45.6, CI 35.1 – 56.1), Illinois (46.4, CI 35.0 – 57.8 ), New Jersey (55.2, CI 43.6 – 66.8),  and New York (43.8, CI 33.1 – 54.6).   In both 2011 and 2012, primary care physicians were less likely to accept new Medicaid patients compared to specialists in the nation as a whole.  Considering combined 2011-2012 data, two states had a statistically significantly higher percent of primary care physicians not accepting Medicaid compared to the average for the nation of around one-third:  Alabama (45.2 percent, CI 34.3 – 56.1) and New Jersey (54.1, CI 41.0 – 67.1).   Four states had a statistically significantly higher percent of specialists not accepting Medicaid compared to the national average:  California (44.8 percent, CI 31.6 – 58.0), Florida (43.7 percent, CI 34.1 to 53.3), New Jersey (56.5, CI 45.1 – 67.9), and New York (49.0, CI 37.3 – 60.7). 

The percent of office-based physicians not accepting new Medicaid patients varies widely across specialties and states.  As part of provisions of the Affordable Care Act,  Medicaid payment rates for primary care services provided by primary care physicians are increasing to 100 percent of Medicare rates in 2013 and 2014.    Prior evidence suggests that physicians’ acceptance of Medicaid patients will increase as Medicaid payment rates increase.  Data here provide baseline information from which to measure whether acceptance rates do increase particularly in states which now have low acceptance rates for Medicaid patients and low payment rates compared to other payers.