Low Payments Aren’t Only Factor Keeping Docs Away From Medicaid

It has long been assumed that low payments are the primary reason doctors choose not to serve Medicaid patients.

It now appears, though, that there may be another, no-less important reason:  challenges associated with billing Medicaid.

A new study found that doctors struggle to do busine      ss with Medicaid more than they do with other insurers.  According to the study, doctors reported that 19 percent of the initial claims they submit for caring for Medicaid patients are not paid in full – more than twice as often as they experience that problem with Medicare and nearly four times more often than they do with commercial insurers.  Coupled with Medicaid’s generally lower payments than Medicare and private insurance, many physicians simply choose not to care for Medicaid patients.

Learn more about this obstacle to increasing doctor participation in Medicaid in the Vox article “Medicaid is a hassle for doctors.  That’s hurting patients” and the study on which it is based:  the National Bureau of Economic Research report “A Denial a Day Keeps the Doctor Away.”

Access to Primary Care a Medicaid Problem, HHS OIG Says

hhsOIGMany of the primary care providers that participate in Medicaid managed care programs are inaccessible to those plans’ members, according to a new report by the U.S. Department of Health and Human Services’ Office of the Inspector General (OIG).

As states’ Medicaid rolls grow and they direct more of their Medicaid beneficiaries into managed care plans, those beneficiaries may be encountering difficulty converting their access to health insurance into access to health care.

According to the OIG report Access to Care:  Provider Availability in Medicaid Managed Care,

We found that slightly more than half of providers could not offer appointments to enrollees. Notably, 35 percent could not be found at the location listed by the plan, and another 8 percent were at the location but said that they were not participating in the plan. An additional 8 percent were not accepting new patients. Among the providers who offered appointments, the median wait time was 2 weeks. However, over a quarter had wait times of more than 1 month, and 10 percent had wait times longer than 2 months. Finally, primary care providers were less likely to offer an appointment than specialists; however, specialists tended to have longer wait times.

In response to these problems, the OIG recommended that the Centers for Medicare & Medicaid Services (CMS) work with states to

… (1) assess the number of providers offering appointments and improve the accuracy of plan information, (2) ensure that plans’ networks are adequate and meet the needs of their Medicaid managed care enrollees, and (3) ensure that plans are complying with existing State standards and assess whether additional standards are needed.

This poses a significant challenge for private safety-net hospitals because they serve so many Medicaid patients.

See the complete OIG report here.