Low pay hurts Medicaid access to specialists

Doctors are dropping Medicaid or cutting the number of program enrollees they'll see.

By Joel B. Finkelstein, AMNews staff. July 26, 2004.

Washington -- For Bruce Weinraub, MD, the first hint of referral trouble for his Medicaid patients started with dermatologists a couple of years ago.

"I have one patient with a malignant melanoma who was not able to get follow-up," said the internist from Northampton, Mass.

Next it was dentists and oral surgeons in the area who stopped seeing Medicaid patients. Now a local group of urologists has begun turning away his Medicaid referrals.

"The way I found out about it was a patient calling me and telling me: 'They won't see me.'... It was a bit of a shock."

The difficulties Dr. Weinraub and his patients are facing are symptoms of a growing Medicaid problem -- the program's low pay is driving many specialists away.

Medicaid reimbursement has always been low, if not below the cost of providing services. Advocacy and sometimes lawsuits by local physician groups seem to have sensitized state governments to the effects on access when rates drop too low.

But efforts by state legislatures and health departments to buoy physician reimbursement have consistently focused on primary care, while specialists' fees often have continued to stagnate, according to an analysis of data from 1998 to 2003 that was published in June by the policy journal Health Affairs.

"Overall, there was a 27% increase across all services, but it was 41% for primary care, 10% for obstetric care and 11% for other services. ... That's lower than inflation," said co-author Peter Cunningham, senior health researcher at the Center for Studying Health System Change.