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    9 Dec 2014

    Half of Doctors Listed as Serving Medicaid Patients Are Unavailable, Investigation Finds

    Large numbers of doctors who are listed as serving Medicaid patients are not available to treat them, federal investigators said in a new report.

    “Half of providers could not offer appointments to enrollees,” the investigators said in the report, which will be issued on Tuesday.

    Many of the doctors were not accepting new Medicaid patients or could not be found at their last known addresses, according to the report from the inspector general of the Department of Health and Human Services. The study raises questions about access to care for people gaining Medicaid coverage under the Affordable Care Act.

    The health law is fueling rapid growth in Medicaid, with enrollment up by nine million people, or 16 percent, in the last year, the department said. Most of the new beneficiaries are enrolled in private health plans that use a network of doctors to manage their care. 

    Patients select doctors from a list of providers affiliated with each Medicaid health plan. The investigators, led by the inspector general, Daniel R. Levinson, called doctors’ offices and found that in many cases the doctors were unavailable or unable to make appointments.

    More than one-third of providers could not be found at the location listed by a Medicaid managed-care plan.

    “In these cases,” Mr. Levinson said, “callers were sometimes told that the practice had never heard of the provider, or that the provider had practiced at the location in the past but had retired or left the practice. Some providers had left months or even years before the time of the call.”

    About 8 percent of providers were at the locations listed, but said they did not participate in the Medicaid health plan with which they were supposedly affiliated. Another 8 percent participated in Medicaid, but were not accepting new patients.

    “When providers listed as participating in a plan cannot offer appointments, it may create a significant obstacle for an enrollee seeking care,” Mr. Levinson said. “Moreover, it raises questions about the adequacy of provider networks. It suggests that the actual size of provider networks may be considerably smaller than what is presented by Medicaid managed-care plans.”

    Investigators called 1,800 providers listed by more than 200 health plans under contract with Medicaid in 32 states. In all cases, insurers confirmed that the doctors were supposed to be taking Medicaid patients.

    Among the providers who offered appointments, the median wait time was two weeks. (The number of providers above the median is the same as the number below it.)

    “Over a quarter of providers had wait times of more than one month, and 10 percent had wait times longer than two months,” the report said.

    The delays can have significant implications for patients.

    “For example,” the report said, “a number of obstetricians had wait times of more than one month, and one had wait times of more than two months for an enrollee who was eight weeks pregnant. Such lengthy wait times could result in a pregnant enrollee receiving no prenatal care in the first trimester of pregnancy.”

    Primary care providers, such as family doctors, internists and gynecologists, were less likely to offer appointments than specialists, the report said. But specialists tended to have longer wait times, with a median wait of 20 days, compared with 10 days for a primary care provider.

    Marilyn B. Tavenner, the administrator of the Centers for Medicare and Medicaid Services, agreed with recommendations in the report to ensure access to care for Medicaid beneficiaries and to correct errors in provider directories. “Inaccurate provider directory data may unnecessarily delay an enrollee from selecting a provider,” she said.

    Dr. Rachel Z. Chatters, a pediatrician in Lake Charles, La., who cares for hundreds of Medicaid patients, said it was difficult to find doctors for them when they became adults. In addition, Dr. Chatters said in an interview on Monday, “It’s nearly impossible to find specialty care for Medicaid patients of any age with diabetes, asthma, sickle cell anemia and certain other chronic illnesses.”

    James Golden, director of managed-care plans at the federal Medicaid agency, said he was developing new rules and standards to ensure timely access to care for Medicaid patients.

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