New Jersey has the nation’s lowest percentage of doctors who accept Medicaid patients – while the state is anticipating the addition of more than 200,000 new patients to the program’s rolls.
Healthcare experts said it’s not surprising that a wealthy state like New Jersey would face a shortage of doctors willing to take Medicaid, particularly because a promise of increased funding will expire after next year and since there are plenty of non-Medicaid patients in the state.
In addition, doctors cited the cost of practicing primary care medicine in New Jersey, including high administrative costs and relatively low salaries compared to specialists.
The journal Health Affairs found that 54 percent of New Jersey primary-care doctors didn’t take new Medicaid patients in 2011 and 2012, well above the national average of 33 percent.
The study, based on an annual survey of office-based doctors, looked at only one measure of access and didn’t factor in whether Medicaid patients had difficulty finding providers, geographic proximity, or whether patients experienced long wait times for appointments,
“New Jersey has a tremendous shortage of primary-care physicians and a surplus of specialists,” said Dr. Robert Eidus, principal of Vanguard Medical Group at Cranford, a family practice.
Eidus said primary-care doctors working at or close to capacity frequently can’t accept new Medicaid patients.
He described his difficulty in finding another doctor to join his practice.
“It took me three years to get someone to finally join my practice,” Eidus said. Until the new doctor joined, Eidus only accepted patients from one Medicaid health plan – adding the doctor allowed him to accept patients from a second plan.
“If we make New Jersey more hospitable to primary care, we’ll have more capacity” and doctors will be more likely to accept Medicaid recipients, Eidus said.
Medicaid, funded by the federal and state governments, is the primary system for paying for healthcare for low-income adults and children.
The report comes at a time when the state is preparing to enroll an estimated 234,000 additional residents in Medicaid after Gov. Chris Christie’s decision to expand eligibility for the program under the 2010 Affordable Care Act.
In addition, the country is in the middle of a ta two-year project under the ACA in which doctors are scheduled to receive the same payments for Medicaid patients as they receive from the higher-paying Medicare program.
In New Jersey, the increase in Medicaid payments is 109 percent. However, federal and state officials are still working out details of the payments, which will be postdated to the beginning of the year.
Eidus said his colleagues have been wary of taking on additional Medicaid patients, even with the promised additional money, since the higher payment rates are set to expire at the end of 2014.
“We don’t want to say goodbye to patients once we’ve established a relationship,” Eidus said, adding that doctors will also hesitate to add staff to support additional patients knowing that the fees for those patients will be cut after next year.
The goal of the Health Affairs report was to establish a baseline for comparing doctors’ acceptance rate of Medicaid patients in the future.
Eidus noted that while specialists are paid more than primary-care doctors nationally, the difference is greater in New Jersey.
“I think if the overall (primary care) climate improves, then we’re going to be much more likely to take care of patients who have a less substantial payment structure,” he said.
Joel Cantor, director of the Rutgers Center for State Health Policy, said it’s not surprising that New Jersey doctors accept fewer new Medicaid patients than those in other states.
“We have a large well-to-do population and many of us are well-insured and of course physicians would do much better serving that large population,” Cantor said.
He added, “I also think it’s not as alarming as it may seem at first blush.”
He noted that the more than 1 million state residents enrolled in Medicaid do receive healthcare. The Health Affairs report didn’t examine what portion of Medicaid patients have difficulty finding healthcare providers.
But Cantor didn’t minimize the seriousness of the issue.
“It’s a fairly sick population — some of the sickest,” Cantor said of Medicaid patients. “I think access is a question.”
Cantor said the new patients expected to enroll in 2014 would pose a challenge.
“It’s a fairly sizable addition to our Medicaid roll,” Cantor said.
Supporters of a proposed bill that would allow advanced practice nurses to establish their own practices have cited the need to meet the demand of more Medicaid patients.
Eidus rejected the notion that advanced practice nurses are the answer to the shortage of doctors accepting Medicaid patients. “There’s no evidence that APNs are going to take care of a larger percentage of Medicaid patients” than doctors, he said.
Claudine Leone, government affairs director for the New Jersey Academy of Family Physicians, noted costs affect whether a doctor participates in Medicaid.
Leone said in a statement that doctors must have a good mix of commercially insured and Medicaid patients to subsidize the low payment and high administrative costs associated with Medicaid.
She said a doctor may receive $23 for a 45-minute visit with a Medicaid patient with multiple and complicated chronic diseases. The costs to the practice far exceed the payment.
“That has been the reality in New Jersey for years and has significantly impacted physician participation, regardless of specialty, in Medicaid,” Leone said.
She added that the two-year funding increase is promising and that the NJAFP hopes that the state’s Medicaid program can maintain the higher payment level beyond 2014.