If you provide better Medicaid payment, pediatricians will participate.

“Office-based primary care pediatricians, who had historically been more resistant to [Medicaid] participation than either their subspecialist or safety net and institution-based peers, increased their participation in the Medicaid program nationally from before to after the 2013 to 2014 Medicaid payment increase,” noted Suk-fong S. Tang, PhD, research analyst at American Academy of Pediatrics, and colleagues.

“That we found participation increases in 4 of 5 indicators nationally and by different measures in the majority of studied states speaks to the robustness of our conclusions,” they wrote.

The researchers looked at office-based primary care pediatricians’ participation in Medicaid between 2011 to 2012 and 2015 to 2016 (prior to and following the temporary Medicaid pay increases provided by the Affordable Care Act) across 27 states and found that those accepting at least some new patients insured by Medicaid increased by 3% to 77%. Pediatricians accepting all new patients insured by Medicaid increased by 6% to 43% and those accepting these patients at least as often as new privately insured patients increased by 6% to 56%. The average percentage of patients insured by Medicaid per provider panel increased by 6% to 31%.

“Our findings are even more compelling because one might have expected that widespread implementation problems, delays in increased payment, and the temporary nature of the increases would have blunted an increase in participation,” Dr. Tang and colleagues wrote. They noted that the study “was not designed to directly examine the relationship between fee increase and participation gains.”

“In light of such findings, the cost and benefits of recruiting new participants versus incentivizing existing participants to increase their Medicaid capacity merit further investigation and the potential for both strategies to improve access should be considered,” the authors wrote.

The AAP Friends of Children Fund supported the study. The researchers reported no relevant financial conflicts of interest.

SOURCE: Tang S et al. Pediatrics 2018 Jan. doi: 10.1542/peds.2017-2570 .


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