June 7, 2019 / 7:32 PM / 3 months ago

Fewer psychiatrists take Medicaid patients even as the program has expanded

(Reuters Health) - Fewer and fewer psychiatrists are accepting Medicaid even as increasing numbers of patients have gained mental health coverage through expansion of the program, a new study suggests.

The percentage of psychiatrists taking Medicaid fell from nearly 48 percent in 2010-2011 to 35 percent in 2014-2015, researchers report in JAMA Psychiatry.

With the expansion of Medicaid, providers in some specialties have taken measures to expand capacity, said study coauthor Adam Wilk, an assistant professor of health policy and management at the Rollins School of Public Health at Emory University. “So we wondered if this would be true also of psychiatrists,” he said.

Instead, Wilk and his colleagues found the opposite. The reason, he suspects, is the acute shortage of psychiatrists in the U.S. That shortage is completely changing the way psychiatrists do business, he said.

“Market deficiencies allow psychiatrists to make more money by taking patients who have private insurance,” Wilk said. “In fact, there’s a rising trend among psychiatrists of opting out of insurance altogether.”

For the new study, Wilk and his colleagues pored through the National Ambulatory Medical Care Survey, a nationally representative survey of physicians who were not employed by the federal government, were based in offices and were primarily engaged in direct patient care. The NAMCS asks two pertinent questions: “Are you currently accepting new patients into your practice?” and “From those new patients, which of the following types of payment do you accept?” Medicaid is one of the possible answers to the second question.

The researchers focused on the years 2010 to 2015 and organized the data in two year increments: 2010-2011, 2012-2013 and 2014-2015. A total of 11,521 responding physicians - 95% of the total sample - reported seeing new patients. That included 584 psychiatrists, 4,400 primary care physicians and 6,537 other specialists.

During each two-year period, the percentage of psychiatrists who accepted new patients covered by Medicaid declined: 47.93% in 2010-2011, 44.94% in 2012-2013 and 35.43% in 2014-2015. By comparison, the percentages of primary care physicians accepting new Medicaid patients remained relatively flat: 75.78% in 2010-2011, 71.73% in 2012-2013 and 71.29% in 2014-2015.

“The key message here is that expansion doesn’t necessarily mean better access,” said Eric Roberts, an assistant professor of health policy and management at the University of Pittsburgh Graduate School of Public Health.

That’s unfortunate since “Medicaid disproportionately insures people with serious mental illness,” said Roberts, who was not involved in the new research. “This should be a point of concern for policy makers.”

Dr. Albert Wu was “disappointed, but not really surprised,” by the new findings.

“That’s because I know there is a significant undersupply of psychiatrists, and in fact, all behavioral health specialists,” said Wu, an internist and professor of health policy and management at the Johns Hopkins School of Public Health. “I have frequently had to resort to calling (psychiatrists) I know and cajoling and begging them to squeeze in my patients. The current system is broken.”

Because of the way it is set up, Medicaid is the least appealing of payment options, Wu said. “Medicaid pays low fees, has delays in reimbursement and comes with extra administrative burdens. But its real competition isn’t private health insurance, it’s self-pay. These days many psychiatrists are only taking patients who can pay on their own.”

SOURCE: bit.ly/2Kud53A JAMA Psychiatry, online June 5, 2019.

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