Keeping clinicians involved in Medicaid programs has never been easy. The pay is low and the programs' impoverished patients, many with multiple chronic conditions, can be difficult to manage.
And now, with state programs stepping up their reporting requirements as they struggle to improve quality while lowering costs, a growing number of providers, especially those in independent practices, are disappearing from plan networks.
The physicians' complaint: an inability to keep up with the growing administrative burden.
Dr. Ellen McKnight, a rheumatologist in Pensacola, Fla., who runs an independent practice called Summit Arthritis and Infusion, dropped out of both Medicaid and Medicare over a year ago. Physicians “are miserable now. The administrative work takes time from patient care,” McKnight said. “Their medical degrees are being wasted.”
To stop the exodus, provider practices are turning to outside quality-reporting services that are either offered by independent companies or by in-house units at their managed-care plans. Others seek out software solutions to help doctors keep track of various measures being demanded by states as the price of remaining in the program.
The measures doctors are being asked to report include ER utilization, medication adherence and preventive screenings. All must be tracked while continuing their day-to-day care duties.
The goal of tracking these measures is to get the providers to improve their performance. An increasing number of plans are attaching penalties to poor performance. Some are also winnowing out providers who consistently fail to provide high quality care.
Officials at companies such as AxisPoint Health, a care-management company, say the services they provide are invaluable in meeting care targets. The measures allow physicians to keep track of diabetic patients' blood sugar levels, or search through patient records to determine if some are in need or flu or pneumonia shots.
“Through our data search, we find the people that should have these services, and we perform the outreach, and that helps providers meet those thresholds they are trying to meet,” said Dr. Timothy Moore, executive vice president of health affairs and chief medical officer for AxisPoint Health.
At Texas Children's Hospital in Houston, AxisPoint Health has embedded care coordinators who provide clinicians with access to state data and help maintain timely preventive-care visits, optimize asthma management for high-risk patients, and reduce inappropriate emergency room and hospital visits, according to Dr. Carl Tapia, a physician at the hospital's Special Needs Primary Care Clinic.
“AxisPoint Health allowed us to leverage their system of education, social and behavior supports to contact patients and even visit them in the home, giving us rich information about health status and barriers to healthcare,” Tapia said.
The use of quality-reporting services by physicians is likely to grow as HHS steps up its efforts to tie quality measures to reducing costs in its Medicare and Medicaid programs. “There's no question that (reporting), which can take away a physician's attention and time that might otherwise be spent directly interacting with patients, has increased in recent years,” said Andrew Shin, senior director of policy and strategic partnerships at the not-for-profit Schwartz Center for Compassionate Healthcare in Boston. “Medicare and Medicaid have played an important role in that.”
Florida in 2014 transitioned most of its Medicaid population into managed care. Florida is one of the 39 states that has turned to private insurers to manage much or all of its Medicaid population.
As with most states using managed care for Medicaid, Florida's plans must meet various quality measures or else face monetary sanctions. Those penalties have led the health plans administering the program in turn to step up their pressure on providers to track the necessary information.
And that is leading some physicians to abandon the program. In an annual state survey of state doctors unwilling to accept new Medicaid beneficiaries, 21.9% of respondents cited paperwork or billing requirements as a rationale in 2015, up from 12.4% in 2013.