Medicaid payment increases tied to greater pediatrician participation

(Reuters Health) - - When state Medicaid programs increased physician payment rates, more pediatricians agreed to treat low-income kids covered by the health insurance program for the poor, a U.S. study suggests

Researchers examined the proportion of pediatricians accepting Medicaid before and after payments increased in 2013 and 2014 - and found gains in participation nationwide as well as in most studied states.

“When many doctors refuse to accept Medicaid patients or place restrictions on patient access to care, it becomes harder for parents to find quality physicians for their children within a reasonable geographic area,” said senior study author Dr. Andrew Racine, a researcher at Albert Einstein College of Medicine and Montefiore Health System in Bronx, New York.

“Patient needs often go unmet and necessary care may be delayed, resulting in avoidable emergency room visits and hospital admissions,” Racine said by email. “The long-term consequences include poorer outcomes for the patients and ultimately higher health care costs for the country.”

Before the payment increases, Medicaid fees for primary care services for all age groups were typically 59 percent of the amount paid by Medicare, the U.S. health program for the elderly, researchers note in Pediatrics.

An estimated 36 percent to 48 percent of U.S. children are insured by Medicaid, and kids make up 53 percent of Medicaid enrollees.

But Medicaid payment for pediatric primary care services averaged 64 percent of payment from Medicare and 53 percent of payment from private insurance before 2013, when Medicaid payments were raised as part of the Patient Protection and Affordable Care Act.

For the current study, researchers examined data from nationwide surveys of pediatricians done by the American Academy of Pediatrics that assessed how many doctors accepted Medicaid and what proportion of patients were insured by the program.

The proportion of pediatrics practices accepting at least some new Medicaid patients increased 3 percentage points to about 77 percent after the payment increases.

At the same time, the proportion of practices accepting all new Medicaid patients increased almost 6 percentage points to about 43 percent. And the proportion of doctors taking at least as many Medicaid as privately insured patients climbed almost 6 percentage points to about 56 percent.

Plus, the proportion of pediatricians not accepting any Medicaid patients dropped 2 percentage points to less than 15 percent.

One limitation of the study is that it relied on physicians to accurately recall and report the proportion of Medicaid patients they accepted, the authors note. The study also focused on pediatricians in private practice, not at community clinics or safety net facilities.

Even so, the results offer fresh evidence that payment increases can work as intended, particularly in getting physicans who accept Medicaid to take on more patients with this type of coverage, said Judith Solomon, vice president for health policy at the Center on Budget and Policy Priorities in Washington, D.C.

“That’s important, because even if new providers didn’t sign up because the increase was only for two years, others who were already participating increased and/or maintained their level of participation, which is important for access,” Solomon, who wasn’t involved in the study, said by email.

“It suggests that increasing payment rates increases participation defined broadly to include the degree of participation of providers already taking patients,” Solomon added. “Having the participation of a broad array of doctors including those in private practice is important so kids can get care when they need it and that they can have an ongoing relationship with a pediatrician.”

The study also suggests that any reduction in payments associated with proposed cuts to the Children Health Insurance Program (CHIP), which operates in tandem with Medicaid in most states, could mean less access to care, said Brendan Saloner, a researcher at the Johns Hopkins Bloomberg School of Public Health in Baltimore.

“If CHIP funding runs out - and that seems to be what is happening as of this month in many states - that will lead children to be dropped from the program and will cause many pediatricians to rethink whether to participate in CHIP, since they will not have assurance that the bills will continue to get paid,” Saloner, who wasn’t involved in the study, said by email.

SOURCE: Pediatrics, online December 22, 2017.