Ketsche, Patricia G

Rencher, William C

Smith, Jessica C

Willis, Carla J

English

Georgia State University

Patient Access in Medicaid: Provider response to Enhanced Payments

ScholarWorks @ Georgia State University

Georgia State University ScholarWorks @ Georgia State University GHPC Materials Georgia Health Policy Center 6-13-2017 Patient Access in Medicaid: Provider response to Enhanced Payments Patricia G. Ketsche Carla J. Willis Jessica C. Smith William C. Rencher Follow this and additional works at: https://scholarworks.gsu.edu/ghpc_materials Recommended Citation Ketsche, Patricia G.; Willis, Carla J.; Smith, Jessica C.; and Rencher, William C., "Patient Access in Medicaid: Provider response to Enhanced Payments" (2017). GHPC Materials. 127. https://scholarworks.gsu.edu/ghpc_materials/127 This Article is brought to you for free and open access by the Georgia Health Policy Center at ScholarWorks @ Georgia State University. It has been accepted for inclusion in GHPC Materials by an authorized administrator of ScholarWorks @ Georgia State University. For more information, please contact scholarworks@gsu.edu. RESEARCH OBJECTIVETo assess provider response to a temporary increase in Medicaid payments for primary care services.  Patient Access in Medicaid: Provider response to Enhanced PaymentsPatricia G. Ketsche, Ph.D.; Carla J. Willis, Ph.D.; Jessica C. Smith, Ph.D.; William C. Rencher, J.D., M.P.H.Georgia Health Policy Center, Andrew Young School of Policy Studies, Georgia State University, Atlanta, GAPOLICYThe Affordable Care Act mandated that Medicaid payments for primary care services equal Medicare rates during calendar year (CY) 2013 and 2014. In order to receive the higher reimbursement, providers were required to certify eligibility.  Primary care was defined as services, including vaccinations, provided by a physician who specialized in family medicine, general internal medicine, pediatric medicine, or a subspecialty recognized by one of three national medical boards. Nationwide, reimbursement rates increased, on average, 73%. Reimbursement rates for Georgia providers increased, on average, 48%.1 Provider locations that attested by August 31, 2013, were eligible for retroactive reimbursements starting on January 1, 2013, and extending through December 31, 2014. Provider locations that did not attest by the due date were eligible for increased reimbursement for eligible services from the month that they attested through the end of the program. Providers who practiced in multiple locations were required to attest separately for each of their locations.STUDY DESIGN• Analyzed Georgia Medicaid claims data from 2011-2014.• Produced descriptive statistics on the number of primary care providers (PCP) participating in the Medicaid program in the two years prior to and during the PCP- enhanced payment, provider location, number of eligible claims, and number of unique patients.  • Categorized providers into three groups: never attested, attested prior to August 31, 2013, and attested after August 31, 2013.• Bivariate analysis to compare provider participation rates and utilization measures for the pre- and post- enhanced payment periods. PRINCIPAL FINDINGS• There was a net, 4% increase in the number of providers seeing a patient for eligible services in 2012 compared to 2011. In the year after enhanced payments were in place, the increase was 7.8%, almost twice as high as during the baseline period. • Provider locations that served a higher concentration of Medicaid patients a priori were most likely to certify eligibility for enhanced payments in the first year of the program (142 Medicaid patients/location versus 32 in locations serving a lower concentration of Medicaid patients). These certifying locations increased their patient loads three-times more than non-certifying locations in the first year of the enhancement (25% versus 8%).  • Locations that certified eligibility for the enhanced payment during the second year increased volumes even more over the prior year (94% versus 33%).  • The number of claims per patient did not change with the enhanced payment. CONCLUSIONEnhanced Medicaid payments for primary care services was associated with increasing the number of unique providers who participated in the Medicaid program, above what was expected from the baseline growth rate. Additionally, the providers who received these enhanced payments saw more Medicaid patients per location. We found no evidence that the number of claims per patient increased.  IMPLICATIONS FOR POLICY OR PRACTICEIncreasing the reimbursement for primary care providers was designed to enhance access by increasing participation and increasing the availability of appointments for enrollees. Despite its temporary nature, the fee enhancement was associated with an increased provider supply and enhanced access for patients seeking health care services.POTENTIAL IMPACTS ON ACCESS TO CAREThe increased reimbursement could have expanded access by increasing: • Number of participating primary care providers or provider locations• Number of Medicaid patients seen by participating primary care providers • Number of services rendered to Medicaid patients  Alternatively, the perception that this enhanced reimbursement was temporary could result in no change in provider behavior.LITERATURE  • Public programs, such as Medicaid, have historically paid physicians less than private insurance.2 • Low reimbursement rates are the most commonly cited reason for low physician participation in the Medicaid program.3 • Increasing provider reimbursements has been shown to increase patient access to health care by increasing the number of available providers4 and shortening wait times for appointments.5 • Reimbursement increases have also been shown to increase the number of providers who accept Medicaid and who accept new patients.2 • Although no studies were found that looked at temporary fee increases, many providers have expressed uncertainty over future reimbursement levels1 which may imply that a temporary increase in fees would be less effective than a permanent one.POPULATION STUDIEDGeorgia Medicaid providers eligible to receive enhanced primary care payments and Medicaid enrollees accessing care through these providers.  REFERENCES1 Long, S. K. (2013). Physicians may need more than higher reimbursements to expand Medicaid participation: findings from Washington State. Health Affairs, 32(9), 1560-1567.2 Decker, S. L. (2007). Medicaid physician fees and the quality of medical care of Medicaid patients in the USA. Review of Economics of the Household, 5(1), 95-112.3 Sommers, A. S., Paradise, J., & Miller, C. (2011). Physician willingness and resources to serve more Medicaid patients: perspectives from primary care physicians. Medicare& Medicaid Research Review, 1(2).4 Hadley, J. (1979). Physician Participation in Medicaid: Evidence from California. Health Services Research, 14(4), 266-280.5 Resneck, J., Jr., Pletcher, M. J., & Lozano, N. (2004). Medicare, Medicaid, and access to dermatologists: the effect of patient insurance on appointment access and wait times. Journal of the American Academy of Dermatology, 50(1), 85-92.ANDREW  YOUNG SCHOOL O F  P O L I C Y  S T U D I E SFor more information, please contact the Georgia Health Policy Center at 404.413.0314 or visit us online at www.ghpc.gsu.edu

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Patient Access in Medicaid: Provider response to Enhanced Payments

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