Medicaid Doctor Shortage Looms?

August 9, 2013

Reports from the Wall Street Journal last month indicated that doctors are increasingly opting out of the Medicare program. But new numbers from CMS indicate that doctor’s biggest issue may not lie with Medicare, but instead with Medicaid.

The Wall Street Journal article reported that the number of doctors leaving the Medicare program has risen from 3,700 in 2009 to 9,539 in 2012. We wrote about this issue a few weeks ago.

While more doctors are leaving the program, there are also many more joining it. CMS reported that, “the number of physicians who agreed to accept Medicare patients continues to grow year-over-year, from 705,568 in 2012 to 735,041 in 2013.” In just the past year, 30,000 doctors entered Medicare, vastly outweighing the 6,000 that opted out over the past 3 years.

While Medicare payments may continue to be an issue for doctors, Medicare patients remain a vital part of many doctors’ practices. Reid Blackwelder, president-elect of the American Academy of Family Physicians, stated that Medicare patients make up 24% of the patient population for AAFP members.

So Medicare isn’t perfect, reimbursement rates and the annual doc-fix are still a point of contention for doctors, but the importance of Medicare patients keeps the majority of doctors in the program.

Medicaid participation tells a different story.

Reports show that less than 70% of the nation’s doctors accepted Medicaid in 2012. And the numbers aren’t getting any better. In a new Health Affairs Study, it was found that about 33% of primary care physicians didn’t accept new Medicaid patients last year.

Reimbursement rates for Medicaid patients are low; payments for procedures are much higher through private insurance than the same procedure for a Medicaid patient. The Affordable Care Act provides a 30% pay hike to primary care physicians who treat Medicaid patients, but the growing number of Medicaid recipients is also a concern. As many as 16 million Americans are expected to gain coverage through Medicaid in the coming years, and doctors may be faced with more patients than they can manage.

The good news is that the availability of doctors who accept Medicare patients appears to be adequate, and will continue to be so. Instead, perhaps the focus needs to be placed on helping doctors continue to accept, and prepare for the increasing numbers of Medicaid patients.

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