Paperwork, low pay driving physicians from Medicaid

Care for beneficiaries is shifting from small, office-based practices to larger groups and institution-based practices.

By Beth Wilson, AMNews correspondent. Sept. 4, 2006.

Fewer physicians are accepting Medicaid patients, and those who do are becoming increasingly concentrated, according to a new national study. Low and slow reimbursement and the heavy paperwork burden are largely to blame.

The study, conducted by the Center for Studying Health System Change, found that in 2004-05, almost 15% of physicians reported receiving no Medicaid revenue, up from 13% in 1996-97. About 21% reported accepting no new Medicaid patients in 2004-05 -- a rate six times higher than for Medicare patients and five times that for privately insured patients.

Gary Floyd, MD, a pediatrician who serves as the medical director of urgent care and public policy for the Cook Children's Health Care System in Forth Worth, Texas, is no stranger to the forces driving the trend. About 38% of physicians in his state accept new Medicaid patients, down from 67% in 2000-01, a Texas Medical Assn. survey found.

"We're seeing more and more physicians dropping out," Dr. Floyd said. Conversely, the state's total Medicaid case load grew by 54% from fiscal year 2000 to 2005, according to the state's health and human services commission.

The burden then tends to fall on emergency departments, Dr. Floyd said. "That's where we see [Medicaid patients] the most, and when we ask about their primary care physician or a medical home, they don't have one."

Dr. Floyd cites two main factors for the shrinking number of physicians accepting Medicaid -- high administrative burden and low reimbursement rates, which cover about half the cost of a patient visit.