High Medicaid population state reports record low access

It’s becoming more difficult for Texas Medicaid patients to find a doctor. A survey released July 9 by the Texas Medical Assn. reported that regulatory burdens and other administrative hassles are forcing physicians to reduce the number of patients on government health care programs whom they will accept.

“This is not about physicians wanting to abandon Medicaid patients,” TMA President Michael E. Speer, MD, said. He said Medicare and Medicaid “have more and more paperwork and more and more rules,” which results in less time to see patients.

Medicaid patient access is the hardest hit, the survey found. The portion of Texas physicians available to treat new Medicaid patients has dropped from 42% in 2010 to 31% this year, “an all-time low,” according to the survey. The Medicaid program in Texas covers 3.4 million people. 

Cuts to Medicaid payment rates of 2% in 2010 and 2011 have made it difficult for physicians to practice, as payments now cover less than half of the average cost to practices of providing the services, Dr. Speer said. At the beginning of 2012, pay for physicians to treat Medicare-Medicaid dual-eligible patients was cut an additional 20%. “Every business has a breaking point; physicians’ practices are no different,” he said.

The TMA in its survey detailed various experiences from individual physicians who had to limit access to Medicare and Medicaid patients. Thomas J. Parr, MD, an orthopedic surgeon in Sugar Land, Texas, had to make a financial decision several years ago to stop accepting Medicaid patients, said his wife, Joannie Parr, an accountant who manages her husband’s medical practice. “Medicaid puts up so many hurdles, we found it was easier to provide free care outright than hassle with Medicaid’s bureaucracy for basically no pay,” she said.

Dr. Parr treats low-income patients referred to him by a free clinic and volunteers his surgical services at a local hospital, the survey noted.

The situation with Medicare isn’t much better, the TMA indicated. “Doctors have answered the government mandate to invest in expensive health information technology, upgraded their coding and billing systems, implemented [electronic prescribing] programs, withstood the threat of a new 60,000-item medical coding system (ICD-10), and for the past decade endured the payment uncertainty of Medicare,” Dr. Speer said in a statement.

The portion of Texas physicians accepting all new Medicare patients declined from 66% in 2010 to 58% in 2012, according to the survey. The portion of physicians limiting how many new Medicare patients they accept and those declining all new Medicare patients each rose by 4% in the past year.

These are the lowest-ever new-patient acceptance rates the association has seen, Dr. Speer said.

Citing the continuing burden of Medicaid on the state budget, Texas Gov. Rick Perry joined at least a half-dozen other Republican governors who said they would opt out of expanding Medicaid enrollment in 2014, following the U.S. Supreme Court’s ruling on the Affordable Care Act. The ruling effectively made this provision of the law optional for states.

In a statement on the court’s decision, Texas Health and Human Services Executive Commissioner Tom Suehs indicated that state officials wanted to work with the Legislature to try to improve care and lower costs for the Medicaid program. Reforms made possible through a new program waiver “will replace an archaic federal Medicaid funding system with one built around local solutions that rewards hospitals for patient care and innovation. This will lay the foundation for true Medicaid reform in Texas and allow us to use existing funding to improve access to care,” Suehs said.

To Dr. Speer, reform means removing the roadblocks to care. “I don’t know if you’ve ever seen an application form for Medicaid. I consider myself to be pretty well-educated, and I could not fill it out without help.” This exemplifies just one of the barriers to obtaining Medicaid, he said. Physicians would like to take care of the patient, “but the patient has got to be able to get to us.”

The TMA report is available online (link).