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For Medicaid patients, access is good overall

RICHMOND—Virginia Medicaid recipients are generally able to get primary care and hospital care but have more trouble finding specialists and mental health treatment, a new report says.

The report comes from the Joint Legislative Audit and Review Commission. Lawmakers asked JLARC—the legislative research arm—to look into how Medicaid reimbursement rates affect access to care.

The report, presented Tuesday, shows that Medicaid recipients access care from hospitals, pharmacies and nursing homes at about the same rate as people who have private insurance.

The same goes for hospitals with psychiatric beds and outpatient facilities, although there is more regional variation, the report said.

But it’s harder for Medicaid recipients to get treatment from specialists because fewer than half of specialists—47 percent—accept Medicaid patients.

And only 23 percent of outpatient mental health providers treat Medicaid enrollees, the report said. Community service boards do provide mental health treatment for Medicaid recipients but often have waiting lists.

The report said Medicaid recipients are generally able to get access to primary care physicians, but have a lower utilization rate for those services. Medicaid recipients use preventive care at lower rates, the report said, and have more hospital visits for chronic conditions that could have been prevented.

Access to various health care services differs by region, the report said. Medicaid recipients have less access in Southside and on the Eastern Shore. The report also showed less access in Northern Virginia, although Ellen Miller, JLARC’s project leader on the report, said the Northern Virginia issues didn’t reflect an actual lack of access, but instead reflect lower rates of utilization of health services by Medicaid recipients there.

The report said statewide, 75 percent of primary care physicians actively treat Medicaid patients—with “active” being defined as treating 10 or more Medicaid patients in 2012.

The question of access to doctors and to care has come up in the debate over whether Virginia should expand Medicaid eligibility. If the state did expand eligibility and add more people to the Medicaid rolls, a question is whether the state has enough doctors —and enough who accept Medicaid patients—to care for them.

The JLARC report did not address that question directly.

The report said doctors would generally be more interested in accepting Medicaid patients if payments were higher.

Medicaid reimbursement rates, which are set by the state, aren’t intended to reflect the actual cost of care, the report said, but are instead intended to be high enough that enough providers will accept them so that access to care for Medicaid recipients is comparable to the general population.

Medicaid in Virginia pays doctors about 76 percent of outpatient costs, the report said.

Medicaid reimbursement rates are lower than Medicare’s reimbursements and lower than average rates paid by private insurers.

For example, the report looked at the rates paid for an established patient’s visit to a physician’s office. Medicaid would pay $55, Medicare would pay $71—and a private insurer, paying a doctor in the VCU Health System, would pay $110. The ratio of Medicaid to Medicare reimbursements is better than the national average in Virginia, the report said.

Few doctors have seen large rate increases in the past decade, although dentists and OB/GYNs had 30 percent and 34 percent rate increases, respectively, in 2005.

Hospitals have been reimbursed more than three-quarters of their costs for Medicaid patients since 2006, but payment rates for some services—such as cesarean sections, psychiatric care, respiratory disorders and COPD treatment—have dropped since 2008.

Medicaid has been one of the biggest drivers of Virginia state budget growth for years because of increasing enrollment and increasing costs of care, and lawmakers have been looking for ways to better control that growth.

A small survey of rate increases for OB/GYN and pediatric services didn’t show much correlation between payment rates and physician acceptance of Medicaid patients, the report said. But it noted that larger, national studies have shown a stronger link between payment rates and doctors’ willingness to accept Medicaid patients.

A federal Government Accountability Office survey of doctors in 2011 found that 78 percent said low reimbursement rates are a reason why their Medicaid participation is limited. More than 60 percent also referred to delayed reimbursements and onerous paperwork.

Sen. Walter Stosch, R–Henrico, who initiated the study, said he thinks the state should look at faster reimbursements and lessening paperwork as ways to entice more doctors to participate in Medicaid.

The JLARC report recommended that lawmakers ask the Department of Medical Assistance, which runs Medicaid, for annual reports on access and utilization.

Chelyen Davis: 540/368-5028