Calling all doctors: what type of insurance do you accept?

Primary Care Access for New Patients Invited Commentary Research 31. SKA32(7):1183-1187. 32. Kenney GM, Huntress M, Buettgens M, Lynch V, Resnick D; Urban Institute. State and local coverage changes under full implementation of the Affordable Care Act. Washington, DC: Kaiser Commission on Medicaid and the Uninsured; July 2013. 39. The Center for Health Information and Analysis, Commonwealth of Massachusetts. Massachusetts household and employer insurance surveys: results from 2011. http://www.mass.gov /chia/docs/r/pubs/13/mhisreport-1-29-13.pdf. 2013. Accessed August 6, 2013. 33. Payments to Primary Care Physicians. Health Care and Education Reconciliation Act of 2010. Pub L No. 111-152, §1201, 124 Stat 1029 (2010). 34. Galewitz P. Few Medicaid docs have seen 2013 pay raise. Kaiser Health News. July 16, 2013. http: //capsules.kaiserhealthnews.org/?p=20786. Ac- cessed January 22, 2014. 35. Supreme Court of the United States. National Federation of Independent Business et al v Sebelius, Secretary of Health and Human Services, et al. http://www.supremecourt.gov/opinions/11pdf /11-393c3a2.pdf. Accessed July 23, 2013. 36. Urban Institute. 10.3 million poor uninsured Americans could be eligible for Medicaid if states opt for ACA expansion. http://www.urban.org /health_policy/health_care_reform/map.cfm. Ac- cessed January 29, 2014. 37. Kenney GM, Lynch V, Haley J, Huntress M. Variation in Medicaid eligibility and participation among adults: implications for the Affordable Care Act. Inqury. 2012;49:231-253. 40. Long SK, Stockley K, Nordahl KW. Coverage, access, and affordability under health reform: learning from the Massachusetts model. Inquiry. 41. Kenney GM, Zuckerman S, Goin D, McMorrow S. Virtually every state experienced deteriorating access to care for adults over the past decade. Ur- ban Institute. http://www.urban.org /UploadedPDF/412560-Virtually-Every-State -Experienced-Deteriorating-Access-to-Care-for -Adults-over-the-Past-Decade.pdf. May 2012. Ac- cessed August 27, 2013. 42. Trapp D. Texas Medicaid managed care expansion approved. American Medical News. Janu- ary 2, 2012. http://www.amednews.com/article /20120102/government/301029956/7/. Accessed August 26, 2013. 43. Pavle K, Mitzen P. The transition to Medicaid managed care in Illinois: an opportunity for long-term services and supports systems change. http://hmprg.org/assets/root/Long%20Term %20Care/2013/MLTSSReport.pdf. July 2013. Ac- cessed August 26, 2013. 44. Final phase of medicaid managed care expansion begins soon. Health Law PA News. No- vember 2012. http://www.phlp.org/wp-content /uploads/2012/12/Nov-2012-Final-Draft.pdf. Ac- cessed August 26, 2013. 45. Oregon Health Authority. Coordinated care organization implementation proposal. House Bill 3650: Health Care Transformation. http://www.oregon .gov/oha/OHPB/meetings/2012/2012-0110-cco.pdf. January 10, 2012. Accessed August 26, 2013. 46. Decker SL. In 2011 nearly one-third of physicians said they would not accept new Medicaid patients, but rising fees may help. Health Aff (Millwood). 2012;31(8):1673-1679. 47. Medicare Payment Advisory Commission. Report to the Congress: Medicare Payment Policy. Washington, DC: Medicare Payment Advisory Com- mission; 2012. 48. Medicaid and CHIP Payment and Access Commission. Report to Congress on Medicaid and CHIP. Washington, DC: Medicaid and CHIP Payment and Access Commission; 2011. 49. Bindman AB, Chu PW, Grumbach K. Physician Participation in Medi-Cal, 2008. Oakland, CA: Cali- fornia Healthcare Foundation; 2010. Invited Commentary Calling All Doctors What Type of Insurance Do You Accept? Andrew B. Bindman, MD; Janet M. Coffman, PhD Through coverage expansion, the Patient Protection and Af- fordable Care Act (ACA) is expected to reduce a major barrier to health care access, the cost of care. However, the law does not ensure that an adequate number of physicians are avail- able and willing to accept a patient’s form of coverage. One of the main ways that the ACA expands coverage is through the Medicaid program. One particular concern has been whether enough physicians are available to meet the demands for the care of these patients. 1 Some of the greatest increases in Medicaid coverage are projected to occur in geographic areas that already have practi- tioner shortages regardless of Related article page 861 payment type. Low Medicaid reimbursement rates further compound the problem. In general, Medicaid programs pay phy- sicians less than Medicare and commercial insurers. 2 Physi- cians are not required to accept Medicaid patients, and re- search indicates that physicians are less willing to accept these patients in states with lower payment rates. 3 There is no systematic monitoring of whether physicians are willing to accept patients with Medicaid coverage. A com- mon approach is to ask physicians through a survey. How- ever, physician nonresponse and inaccurate reporting can un- dermine the validity of the results. jamainternalmedicine.com In this issue, Rhodes et al 4 describe a strategy for deter- mining physicians’ willingness to accept new patients with dif- ferent types of insurance that closely reflects patients’ expe- riences. They used a simulated patient methodology, which relied on trained staff using a script to call primary care of- fices in 10 states and request a new patient appointment. By using a reproducible clinical scenario and varying the ex- pected payer information, the investigators were able to esti- mate the willingness of a sample of practices to accept pri- vately insured, Medicaid, and uninsured patients. The study was performed during the year before the ex- pansion of Medicaid as a part of the ACA. The findings con- firm what physician surveys had previously suggested: there is variation in physicians’ willingness to accept new Medic- aid patients across states, and in all states this rate is lower than the rate for privately insured patients. On average, callers with Medicaid coverage were only 68.4% as likely as privately in- sured callers to obtain a new patient appointment from a pri- mary care physician for the same clinical problem but almost 4 times as likely as uninsured callers with a limited ability to pay. Among callers obtaining an appointment, wait times did not differ by insurance status. The simulated patient methodology offers some advan- tages over physician surveys. It is not subject to nonresponse JAMA Internal Medicine June 2014 Volume 174, Number 6 Copyright 2014 American Medical Association. All rights reserved.