New Medicaid patients will lack access, most doctors say

Washington -- Most primary care physicians say new Medicaid enrollees will have trouble finding the doctors they need, but increasing Medicaid pay higher than current law would solve that problem, according to an insurance industry poll.

The health reform law will expand Medicaid starting in 2014 and increase Medicaid primary care pay to Medicare rates in 2013 and 2014. However, just 10% of primary care physicians surveyed last fall believed new Medicaid enrollees in their area would be able to find a suitable primary care doctor, while 67% did not, according to a survey by UnitedHealth Group's Center for Health Reform & Modernization, released on April 15. The rest were undecided.

The pay increase in the reform bill is a welcome step, said Simon Stevens, report co-author and executive vice president of UnitedHealth Group. "But we don't think that just doing it for two years will necessarily be sufficient."

The poll found that 49% of primary care physicians would be willing to see new Medicaid patients if Medicaid pay reached Medicare levels; 47% would not. If Medicaid pay were increased to private insurance rates, 81% said they would accept new Medicaid patients. Maintaining Medicaid pay at Medicare levels for the rest of the next decade would cost an additional $50 billion, the report's authors estimated.

Still, states may be able to maintain the elevated Medicaid pay rates because they will be receiving much more federal Medicaid support, said Cynthia Mann, who oversees the Medicaid program at the Centers for Medicare & Medicaid Services. The federal government will pay all of the cost of covering new Medicaid enrollees from 2014 to 2016, gradually decreasing its share to about 90% of costs.

American Medical Association President J. James Rohack, MD, said the Medicaid primary care pay increase is crucial. It will help physicians see more Medicaid patients and help patients obtain treatment for diseases before their health worsens, he said.

Managing expectations

Physicians' expectations of Medicaid patient access varied by region. Although 23% of primary care doctors in New York thought new Medicaid enrollees would find a suitable primary care doctor, only 3% of physicians in Texas agreed.

The physician survey was released with a UnitedHealth Group report on reducing spending in Medicaid.

The report's authors suggested that a three-pronged approach would save $366 billion in Medicaid spending over a decade: expanding managed care, fostering adoption of electronic medical records and improving long-term care. Savings should go toward increasing Medicaid physician pay, Stevens said.

AmeriChoice, part of UnitedHealth Group, is the nation's largest Medicaid managed care company. It operates in 22 states and covers more than 2 million enrollees.

The report named Georgia as a state where managed care has provided more extensive care for less cost than fee-for-service Medicaid. The state contracted with three Medicaid managed care plans in 2006.

Some physicians and state Medicaid directors were skeptical about the report's suggestions and savings estimates.

While Medicaid managed care has saved money in Georgia, it has "been to the detriment of physicians and patients," said Donald J. Palmisano, Jr., director of government relations for the Medical Assn. of Georgia. Physician participation in the managed care plans has been hurt by various issues, including delays in certifying new physician participants so they can be paid, he said.

However, managed care plans can help find patients who aren't getting the care they need, said Tim Bartholow, MD, senior vice president at the Wisconsin Medical Society. Managed care plans can locate and contact patients with chronic conditions, such as diabetes, who have not visited a physician recently, he said.

Ann C. Kohler -- director of health services at the American Public Human Services Assn., which includes state Medicaid directors -- said those directors don't find the savings estimates credible. "We haven't seen any documentation to back those numbers up," Kohler said.