More Reasons Why Doctors Do Not Participate in Medicaid

doctor-xray-2This blog has many entries discussing how few doctors participate in Medicaid, the joint state-federal healthcare program for low-income people that ObamaCare expands. One reason is that fees are too low to induce doctors to participate. But even if doctors are willing to accept low fees, they find that Medicaid is the worst payer in their practices:

  • Medicaid programs have the highest number of days to collect payment (days accounts receivable): All payer average = 26 days; Medicaid average = 44 days.
  • Medicaid programs have the highest denial rate: All Payer average = 6.8%; Medicaid average = 18.5%.
  • Medicaid programs have the lowest transparency in electronic explanation of payment and adjudication of claims (electronic remittance advice): All Payer average = 95%, Medicaid average = 89.4%.

And even if a physician does want to enroll in Medicaid, it is often very burdensome to do so:

  • Nearly half of Medicaid programs require enrollment for electronic data interchange (EDI) (10 of 21).
  • Medicaid programs require a signature more frequently than the average payer.
  • 38% of Medicaid enrollments require paper forms that must be mailed in.

National commercial payers have the least burdensome enrollment requirements.

  • None require enrollments for EDI
  • None require enrollment on paper forms sent through the mail

(AthenaHealth, PayerView 2014 report)

Comments (12)

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  1. Thomas says:

    Doctors have plenty of incentives to not accept Medicaid. To improve access to health care, instead of expanding this form of Medicaid, they should have reformed it to be a more well rounded policy.

    • Matthew says:

      You can’t blame the doctors either. They have a business to run. They can’t keep the doors open if they accept too many Medicaid patients. The blame is not upon the physicians, but on the government.

      • James M. says:

        Even when doctors do try to take on Medicaid patients, there are barriers to do so. Access to care should be the number 1 reform, and improving Medicaid should be the first step.

      • Steve says:

        Exactly Matthew, Obama and his cronies will always try to blame the “greedy” doctors and insurance companies rather than admit that its the government red tape that causes such inefficiencies.

        In the meantime, more and more doctors will opt out of Obamacare and reduce their costs by accepting cash payments instead of hiring staff dedicated to doing paperwork and being compensated at such reduced rates. This will be another aspect of his “if you like your doctor, you can keep your doctor” lie.

    • beckygomez says:

      I completely agree! They should fix all of the flaws with the system before they try to expand Medicaid across-the-board. There seems to be no logic with the Obama administration here with regards to Obamacare and the Affordable Care Act (ACA).

      • Dale says:

        Their logic is to put the cart before the horse.

      • Perry says:

        This, in my mind is the biggest problem with the ACA. Expanding insurance coverage without expanding access (poor reimbursement, not enough doctors). What is the point of having insurance if you can’t see a doctor?

  2. Buddy says:

    “More Reasons Why Doctors Do Not Participate in Medicaid”

    As if doctors needed more reasons other than small reimbursement payments.

  3. Big truck joe says:

    Not to mention the Medicaid patients are the most hassle for the least reimbursement. don’t believe me, ask any internal medicine doctor who has treated Mediciad vs Private insurance payments. You will be surprised as to which population is more demanding and lawsuit threatening….and it ain’t those with jobs who’s employer helps foot their insurance bill each month.

  4. coley odoherty says:

    Re: “National commercial payers have the least burdensome enrollment requirements” – I understand and agree with the other comments but would ask clarification on the statement above. Many commercial insurers also run Medicaid plans (I believe the number is around 37 states have private insurers run the plans.)

    • John R. Graham says:

      Thank you, and that is a very good question. Over the last decade or more, private insurers have taken over a large share of the Medicaid market via managed-care plans.

      I cannot answer the question fully, because I did not do the research. However, I expect the answer lies in a phenomenon similar to that which we observe in Obamacare health-insurance exchanges: The government (in the case of Medicaid, usually the county government) is in the mix.

      The information technology of the health plan cannot really be more advanced than that of the government, because the health plan has to exchange data with the government.

      Medicaid managed-care plans are not “risk-bearing” in the same sense that commercial plans or Medicare Advantage plans are. The way I understand it, they are in a middle ground between risk-bearing and claims processing.

      Medicaid managed-care plans do not promote themselves like Medicare Advantage plans do, and don’t enroll beneficiaries directly. Instead, beneficiaries are assigned to them. There is not the same degree of consumer choice as Medicare Advantage.

      Therefore, they will not be as eager to keep a broad network of satisfied providers as commercial or Medicare Advantage plans are. (Although, Obamacare rules on Medicare Advantage will make them behave more like Medicaid managed-care plans in the future, I expect.)

      Anyone with direct experience of Medicaid managed-care, please weigh in!

  5. Devon Herrick says:

    Medicaid pays poorly — only reimbursing doctors about half what private insurers pay for the same service. Over the years I’ve talked to many physicians at conferences who’ve told me they feel it is their charitable / humanitarian duty to see some Medicaid and indigent-care patients. But they also report they cannot keep their practice open just treating Medicaid enrollees (or Medicare beneficiaries for that matter). The argue the government cannot expect them to shoulder the burden for all low-income patients who need care.

    As eligibility has ratcheted up, and more Medicaid enrollees call for appointments, doctors are becoming increasingly wary. Treating a few truly needy patients make doctors feel good. Being inundated by patients who are “less-needy” makes doctors feel overwhelmed and like they are being taken advantage of (both by the patient and the government). This is just one anecdote and should not be given the weight of empirical data, but it’s representative of anecdotes I’ve heard numerous times. At a conference I had a OB/GYN relay a story to me about being told his uninsured patient didn’t have any money to pay for prenatal care, labor and delivery. (We didn’t discuss this but that presumably meant the mother would qualify for emergency Medicaid). When the day arrived and the mother-to-be went into labor, her family showed up in customized, late-model pickup trucks, the men wearing ostrich skin boots and gold jewelry, with video cameras in hand. This doctor told me that later when he left the hospital at the end of the day he walked to his “used” small foreign car that was not nearly as expensive as the cars and trucks owned by the family members of the woman whose baby he just delivered. He felt like he had been taken advantage of. That was the most extreme example he had, but it said less egregious examples occurred on a regular basis.

    As more and more people are enrolled in Medicaid, doctors will stop thinking that treating Medicaid enrollees is their charitable mission and will balk.