Primary care physicians accepted significantly more Medicaid patients after the Affordable Care Act’s mandated Medicaid pay bump, a 10-state study showed.
Researchers at the University of Pennsylvania in Philadelphia and the Urban Institute in Washington, D.C., found that appointment availability for new Medicaid patients increased from 59% before the pay increase to 66% after, according to the study published Jan. 21 in the New England Journal of Medicine. Appointment availability for privately insured patients showed no major change in the same time period (doi:10.1056/NEJMsa1413299).
The Medicaid pay bump had a dramatic effect on physicians’ willingness to take on more Medicaid patients, according to the study’s lead investigator, Daniel Polsky, Ph.D., of the University of Pennsylvania.
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“A lot of people were saying that doctors are not going to change how they see patients just for a policy that’s going to be in place for 2 years,” Dr. Polsky said in an interview. “When we started the study, a lot of people were predicting we weren’t going to find anything. When we got the data back … we were quite surprised at the magnitude of what we found.”
To assess the impact of the Medicaid pay bump, field staff sought new-patient primary care appointments, presenting themselves as either covered by Medicaid or by private health insurance. Callers contacted primary care practices in Arkansas, Georgia, Illinois, Iowa, Massachusetts, Montana, New Jersey, Oregon, Pennsylvania, and Texas during two periods: November 2012 through March 2013 and from May 2014 through July 2014. Practices were chosen randomly and callers were assigned to a script requesting a new-patient appointment for routine care or an urgent health care concern. A total of 7,753 calls were placed during the first period and 4,225 during the second.
States with the largest increases in Medicaid appointment availability also tended to be those with the largest increase in Medicaid payments. An exception was Montana, which had the smallest change in Medicaid reimbursements of the 10 states but still had an increase of 6.8 percentage points in Medicaid appointment availability. Although new appointments became more available, waiting times changed little over time and did not correspond to the changes in payments, Dr. Polsky and his colleagues found.
Providing higher Medicaid payments appears to be an effective strategy for ensuring access to enrollees among already-participating primary care physicians, Dr. Polsky said. Although Congress declined to extend funding for the payment increases past 2014, the investigators noted that 15 states are maintaining the higher rates. In states that are not extending the pay increase, Medicaid payments to primary care physicians are expected to fall between 43% and 47% in 2015, the investigators said.
“Evidence has an influence on policy,” Dr. Polsky said. The results of this study “suggest that if you spent a little bit more paying providers when they saw Medicaid patients, that money wouldn’t go to waste.”
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