Report on Georgetown University Study of Medicaid Reform

Daily Health Policy Report

Medicaid | Florida Medicaid Reform Pilot Program 'Appears To Be Reducing' Number of Participating Physicians, Study Finds
[May 09, 2007]
A Medicaid pilot program in two Florida counties "appears to be reducing" the number of physicians who accept beneficiaries there, according to a study released on Tuesday by the Georgetown University Health Policy Institute, the Miami Herald reports (Dorschner, Miami Herald, 5/9). Former Florida Gov. Jeb Bush (R) in December 2005 signed into law legislation that created a pilot program to shift some of the state's Medicaid beneficiaries to managed care plans and cap spending growth on the program at 8% for the next five years. Under the new system, the state pays HMOs higher rates for treating sicker beneficiaries than for treating healthy beneficiaries. The plan began July 1 in Duval and Broward counties (Kaiser Daily Health Policy Report, 1/31/06).

Of 186 doctors in the two counties who responded to a Georgetown survey, more than 25% who had participated in the Medicaid program before the new plan was implemented said that they no longer would participate. Fifty-one percent of doctors said that the new program's restrictions and requirements made it more difficult to provide medically necessary services to children, according to the study (Miami Herald, 5/9).

Two-thirds of physicians dropping out of the program are specialists, the study found. In addition, nearly 40% of doctors who accept Medicaid beneficiaries have continued treating half or fewer of their patients since the program changed. A significant number of physicians also said that under the new system, paperwork has increased and reimbursement for services has declined or stayed the same, CQ HealthBeat reports (Adams, CQ HealthBeat, 5/8).

Researchers noted that only 8% of doctors responded to the survey, so the findings "should not be considered generalizable to the entire membership of these organizations." Meanwhile, four focus groups each comprising about 10 beneficiaries led the researchers to conclude that fewer than 50% of beneficiaries had spoken to "choice counselors" intended to help them understand their health care options (Miami Herald, 5/9).

Reaction
Joan Alker, lead investigator of the study and a senior researcher at Georgetown, said, "There are a lot of warning signs ... with respect to ... some of the experiences beneficiaries are having, and there's concern about providers leaving the program, which could very significantly affect access to needed care." She added, "The study raises a lot of really important questions that need to be ... addressed before the pilots continue any further."

Florida Agency for Health Care Administration officials in a statement said, "As with all studies based on focus groups and surveys, the information is a snapshot of a specific audience at a specific time. We do not agree with all the findings and have asked the university for their data so we can better understand their analysis and conclusions" (Karkaria, Florida Times-Union, 5/9). A CMS spokesperson said that the agency needed more time to review the study (CQ HealthBeat, 5/8).

The study is available online.