State Medicaid fees and access to primary care physicians

Sharma, Rajiv; Tinkler, Sarah; Mitra, Arnab; Pal, Sudeshna; Susu-Mago, Raven; Stano, Miron

doi:10.1002/hec.3591

Cited by 30 publications

(26 citation statements)

References 17 publications

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“…More generous reimbursement and coverage may account for increased appointment offers to Medicare and privately-insured patients with weight concerns since physicians are sensitive to reimbursements, particularly for non-urgent needs (Clemens and Gottlieb, 2014). The Medicaid program has historically suffered low reimbursement rates which has been found to limit access (Decker, 2012; Sharma et al, 2017). Prior research suggests that states with better Medicaid coverage of tobacco cessation have higher rates of smoking cessation (e.g., Greene et al, 2014), but sensitivity analyses on our data found that access to new patient appointments for patients with smoking concerns was no better in states with better Medicaid coverage of tobacco cessation services.…”

Section: Discussionmentioning

confidence: 99%

“…Data are from an annual, nationwide audit (Sharma et al, 2015; Sharma et al, 2017; Tinkler et al, 2017). Since 2013, trained research assistants (RAs) have called primary care physicians’ offices on behalf of a purported aunt or uncle requesting information about the earliest available new patient appointment for a physical exam.…”

Section: Methodsmentioning

confidence: 99%

“…Revenue depends on reimbursement and coverage, and factors such as patient complexity contribute to costs. Reimbursement varies by insurance type, and Medicaid patients, in particular, face limited access due to low physician payments (Decker, 2012; Sharma et al, 2017). Post-ACA federal regulations mandate coverage of some preventive care for smoking (4 counselling sessions, 90 days of medication, and up to two quit attempts per year) for Medicaid expansion, Medicare, and non-grandfathered private insurance plans.…”

Section: Methodsmentioning

confidence: 99%

“…Following Medicaid expansion, Medicaid enrollment increased more rapidly in expansion states than in non-expansion states (Rudowitz, Snyder, and Smith, 2015). Medicaid policy creates spillover and substitution effects for patients with other insurance coverage (e.g., Sharma et al, 2017; Antonisse, et al, 2017). For example, increased demand from newly insured patients may exacerbate physician shortages.…”

Section: Methodsmentioning

confidence: 99%

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Access to US primary care physicians for new patients concerned about smoking or weight

Tinkler

Sharma

Susu-Mago

et al. 2018

Preventive Medicine

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Tobacco smoking and obesity are leading causes of preventable morbidity and mortality in the US, and primary care physicians are the main source of preventive care. However, it is not known whether access for new patients is affected by an expression of interest in preventive care. In a 2015 audit, we called US primary care physicians' offices to request appointment information regarding new patient physicals for simulated patients. Simulated patients were differentiated by smoking concerns (N = 907), weight concerns (N = 867), or no health concerns ("healthy" patients; N = 3561). Additionally, patient profiles varied by race/ethnicity, sex, and insurance type. We also examined whether access differed in states that expanded Medicaid under the Affordable Care Act. We found that physicians' offices were no more likely to offer appointments to patients with smoking concerns than to healthy patients (54% vs. 55%; p-value = 0.56), and patients with smoking concerns were offered fewer appointments than patients with weight concerns (54% vs. 62%, p-value < 0.01). In analyses adjusted for covariates, smoking concerns did not improve appointment offers for any patient group, and reduced Medicare patients' offers in Medicaid expansion states by 9 percentage points relative to healthy patients (95% CI: -16, -2). Health concerns did not statistically significantly affect waits-to-appointment. Our results suggest that patients with smoking concerns are no more likely to be offered new patient appointments than those with no health concerns. The greater likelihood of appointment offers for some patients with weight concerns is encouraging for obesity prevention and management.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

See 2 more Smart Citations

Access to US primary care physicians for new patients concerned about smoking or weight

Tinkler

Sharma

Susu-Mago

et al. 2018

Preventive Medicine

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“…3 More generally, several studies leveraging pre-fee bump data show that higher Medicaid reimbursement rates or capitation payments for primary care services increased access to primary care. For instance, boosts in the reimbursement rate increased provider acceptance of Medicaid patients (Decker 2012) and appointment availability for enrollees (Sharma, Tinkler et al 2018).…”

Section: Related Literaturementioning

confidence: 99%

Reimbursement Rates for Primary Care Services: Evidence of Spillover Effects to Behavioral Health

Maclean¹,

McClellan²,

Polsky³

2018

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We study spillover effects from the largest increase in Medicaid reimbursement rates in the history of the program for primary care services to behavioral health and healthcare outcomes; mental illness, substance use disorders, and tobacco product use. Much of the variation in Medicaid reimbursement rates we leverage is attributable to a large federally mandated increase between 2013 and 2014. We apply differences-indifferences models to survey data specifically designed to measure behavioral health outcomes over the period 2010 to 2016. We find that higher primary care Medicaid reimbursement rates improve behavioral health outcomes among enrollees. We find no evidence that behavioral healthcare service use is altered. Previous economic research shows that the mandated boost increased office visits. Thus our results suggest that primary care providers are efficient in improving behavioral health outcomes among Medicaid enrollees. Given established shortages of behavioral health providers, these findings are important from a healthcare workforce and policy perspective.

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Association of Simulated Patient Race/Ethnicity With Scheduling of Primary Care Appointments

Wisniewski

Walker

2020

JAMA Netw Open

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IMPORTANCE Racial and ethnic disparities in access to health care may result from discrimination. OBJECTIVES To identify differences in the rates at which patients belonging to racial/ethnic minority groups are offered primary care appointments and the number of days they wait for their primary care appointment and to understand the mechanisms by which discrimination occurs. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study used 7 simulated black, Hispanic, and white patient callers to request appointments from 804 randomized primary care offices in 2 urban centers in Texas from November 2017 to February 2018. Data analysis was conducted between February and December 2018. EXPOSURES Research assistants called randomly assigned offices to schedule an appointment, supplying the same basic information. Race and ethnicity were signaled through callers' names and voices. MAIN OUTCOMES AND MEASURES Appointment offer rates, days to appointment, and questions asked during the call. RESULTS Of the 7 callers (age range, 18-29 years), 2 (28.6%) self-identified as non-Hispanic black, 3 (42.9%) self-identified as non-Hispanic white, and 2 (28.6%) self-identified as Hispanic. Of the 804 calls they made, 299 (37.2%) were from simulated white callers, 215 (26.7%) were from simulated black callers, and 290 (36.1%) were from simulated Hispanic callers. Overall, 582 callers (72.4%) were offered appointments. In unadjusted models, black and Hispanic callers were more likely to be offered an appointment than white callers (black callers, 32.2 [95% CI, 25.1-39.3] percentage points more likely; P < .001; Hispanic callers, 21.1 [95% CI, 13.7-28.5] percentage points more likely; P < .001). However, after adjusting for whether insurance status was revealed, this statistical significance was lost. In adjusted models, black callers were 44.0 (95% CI, 36.2-51.8) percentage points more likely to be asked about their insurance status than white callers (P < .001), and Hispanic callers were 25.3 (95% CI, 17.1-33.5) percentage points more likely to be asked about their insurance status (P < .001) than white callers. Black and Hispanic callers received appointments further in the future than white callers (black callers: marginal effect estimate, 3.650; 95% CI, 0.579 to 6.721; P = .08; Hispanic callers: marginal effect estimate, 2.644; 95% CI, −0.496 to 5.784; P = .02). CONCLUSIONS AND RELEVANCE In this study, black and Hispanic patients were more likely to be offered an appointment, but they were asked more frequently about their insurance status than white callers. Black and Hispanic callers experienced longer wait times than white patients, indicating a barrier to timely access to primary care.

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State Medicaid fees and access to primary care physicians

Cited by 30 publications

References 17 publications

Access to US primary care physicians for new patients concerned about smoking or weight

Access to US primary care physicians for new patients concerned about smoking or weight

Reimbursement Rates for Primary Care Services: Evidence of Spillover Effects to Behavioral Health

Association of Simulated Patient Race/Ethnicity With Scheduling of Primary Care Appointments

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