MediPass Primary Care Physician Network Analysis
Transcription
MediPass Primary Care Physician Network Analysis
MediPass Primary Care Physician Network Analysis: Primary Findings Allyson Hall, PhD Heather Steingraber, MAC (ABT) Steve Shaffer Christy Harris Lemak, PhD Jianyi Zhang, PhD Florida Center for Medicaid & the Uninsured College of Public Health and Health Professions University of Florida 352/273-5059 Sponsored by The Agency for Health Care Administration June, 2004 Introduction Assuring that there is adequate primary care capacity is critical to the success of Medicaid primary care case management programs, such as MediPass. Several earlier studies documented that physician participation in Medicaid varies considerably throughout the country, and there has been a decline in participation in recent years. In 2001, about 85 percent of all physicians throughout the country participated in Medicaid. However, for most physicians, their Medicaid practice tends to be small – contributing less than 10 percent to overall total practice revenues (Cunningham, 2002). Nationally, the number of physicians who will not accept new Medicaid patients increased from 26 percent to 31 percent between 1999 and 2001 (Schoenman, 2003). And, in Alabama and Georgia, the introduction of a primary care case management program similar to MediPass, actually resulted in lower physician participation in Medicaid (Adams, et al, 2003). Low reimbursement levels, burdensome paperwork, and persistently negative opinions about Medicaid are said to be some of the reasons for low physician participation in some communities (Berman et al, 2003; Perloff et al, 1995; Bindman at al, 2003). In Florida, a 2002 evaluation concluded that Florida MediPass had excess primary care capacity. At the time, there were ov er 4,685 contracted providers or groups providing a capacity that was 10 times greater than the enrolled MediPass population. The report noted that in order to keep costs down, Medicaid may want to consider reducing the size of the MediPass network so as to exert control over providers and to assure greater efficiency within the program(Florida Center for Medicaid Issues, 2002). This earlier study relied on data that did not consider whether physicians were accepting new Medicaid patients. Physicians may be contracted with MediPass, but limit their practice to a few existing patients. Thus, while it may appear that a community or region has adequate coverage, this may in fact not be the case if only a few physicians are taking additional patients. In addition, the MediPass program has instituted a requirement that for all program enrollees, a PCP must be located within 30 minutes drive time of their home. Therefore, simply looking at the number of physicians in an area without appropriate consideration of the drive time rule may lead to an overestimation of PCP capacity. To address this issue, the Florida Center for Medicaid and the Uninsured contacted MediPass primary care physicians to learn if they are accepting new Medicaid patients. Mapping analysis then examined the extent to which there is sufficient MediPass primary care capacity throughout the state. Methods Sample Participating MediPass primary care physicians were identified from lists supplied by Medicaid area offices and from a list generated by QueryPath. The various lists were combined resulting in a master list of over 3,000 unique providers identified by their unique provider IDs. Survey The main goal of the project was to collect information on whether physicians were accepting new MediPass patients and to understand some of the barriers MediPass patients may encounter in trying to make appointments with their PCPs. It was important to ensure that interviewers engaged in realistic dialogue with office staff, and that 2 PRELIMINARY FINDINGS – DO NOT QUOTE WITHOUT PERMISSION OF THE AUTHORS interviewers could easily document findings from these conversations. Therefore interviewers used a basic script that asked: whether the provider was accepting new patients in general, whether they were accepting MediPass patients specifically, and if so, how long it would take to get an appointment. Physicians’ offices were generally not aware that they were being surveyed. In a training session, interviewers role-played and tested the script with several initial calls. Modifications were made based on these pilot calls. During and after the call other information was also recorded, such as the length of time the interviewer spent on hold, and the number of times they were transferred. This information was gathered in order to capture the ‘hassle factor’ involved in trying to get an appointment. This information will be reported elsewhere. The data sheet used to collect this information is included in Appendix 1. Data Analysis Florida Medicaid requires a MediPass Providers to be within a 30-minute drive of every enrollee. This criterion was used to create MediPass provider service areas based on 30-minute drive times out in every direction from the provider’s address. Creating drive time service areas for every accepting MediPass provider in the state will allow for the identification of gaps in service. Geographic Information Systems (GIS) is a standard tool for mapping and exploring variation in the demand and supply of health care services (McLafferty, 2003). In this analysis GIS was used to place a point on a map for every MediPass provider by geocoding based on the provider’s address or zip code. MediPass beneficiaries were also geocoded by zip code. Service area polygons were then created by a network analysis of the statewide 3 PRELIMINARY FINDINGS – DO NOT QUOTE WITHOUT PERMISSION OF THE AUTHORS street system radiating out from each provider’s point location. The drive time computation took into account distances and speed limits along the network. Traffic congestion and other travel costs were also taken account by the GIS system. Service areas for each provider were merged together to provide complete coverage area for the state for all accepting providers and for specific provider types, such as pediatricians or ob-gyns. Maps and other data were then produced to show service areas statewide and highlight gap areas where no provider was within a 30-minute drive time of beneficiary zip codes. Findings The series of maps and charts presented here summarize preliminary findings from the survey and mapping exercise. A total of 3,800 physicians were identified as either being on an area office list or were listed in QueryPath. Eighty-eight percent of all physicians surveyed said that they were accepting new patients. However, when probed, a smaller percentage of offices (74 percent) responded that they were actually taking new MediPass patients. With a few exceptions, statewide coverage by MediPass physicians appears to be good. Using the 30-minute drive-time rule discussed earlier, most of the state’s MediPass population appears to have appropriate access to a primary care provider. Areas of concern include parts of south Florida including Monroe county, and communities in south central areas and in the Panhandle. Of particular concern is the lack of pediatric and obstetrics and gynecology physicians in certain areas. 4 PRELIMINARY FINDINGS – DO NOT QUOTE WITHOUT PERMISSION OF THE AUTHORS Figure 1 – Percent of Florida MediPass Physicians by County who are Accepting New Patients The majority of MediPass providers are 100 80 89 88 88 90 83 92 93 90 86 continuing to accept new MediPass 89 83 76 74 71 65 70 patients. When asked, 88 percent of 60 offices said they will see new patients 40 However, when asked specifically about 20 Medicaid patients, 74 percent of 0 providers will see a new MediPass Flo Bro D rid war ade a d Du val Hil Ora P P lsbo nge alm B inella rou s eac gh h Area Office New Patients New MediPass Patients * Includes physicians who are either on an area office or QueryPath list patient. Acceptance of new MediPass patients varies across communities. In Broward only 65 percent of identified MediPass physicians will take a new patient, compared to 86 percent in Duval 5 county. PRELIMINARY FINDINGS – DO NOT QUOTE WITHOUT PERMISSION OF THE AUTHORS Figure 2 – Percent Of MediPass Physicians On An Area Office List Who Are Accepting New Patients Area offices supplied lists of 100 98 97 90 80 92 92 88 85 97 95 85 77 70 96 91 88 85 83 76 74 71 74 MediPass patients. These are the 66 60 59 providers who are accepting new 58 same lists that are given to MediPass 40 beneficiaries. Statewide, 77 percent 20 of physicians on an area office list 0 will see new MediPass patients. This Flo 1 rid a 2a 3 4 5 6 7 8 Area Office New Patients New MediPass Patients 9 10 11 ranges from a low of 58 and 59 percent in Areas 8 and 1 respectively, to a high of 97 percent in Area 4. 6 PRELIMINARY FINDINGS – DO NOT QUOTE WITHOUT PERMISSION OF THE AUTHORS Figure 3 – Percent of MediPass Physicians on An Area Office List who are Accepting New Patients: Statewide, by Specialty Ninety percent of the OB/GYN physicians 100 80 94 91 90 77 87 surveyed will see new MediPass patients, 90 92 90 91 compared to 65 percent of Internal 81 78 65 60 Medicine physicians. Although there are 40 high acceptance rates among OB/GYNs, 20 coverage is inadequate because of the relatively small numbers of participating 0 All FP/ GP Inte OB /GY rna lM N ed Ped s Area Office New Patients Oth er OB/GYN physicians (see Figures 16 and 17). New MediPass Patients 7 PRELIMINARY FINDINGS – DO NOT QUOTE WITHOUT PERMISSION OF THE AUTHORS Figure 4 – MediPass Providers Statewide As expected, most of the MediPass physicians are located in the major metropolitan areas of Miami-Dade, Ft. Lauderdale, West Palm Beach, Tampa, Orlando, and Jacksonville……. 8 PRELIMINARY FINDINGS – DO NOT QUOTE WITHOUT PERMISSION OF THE AUTHORS Figure 5 – MediPass Enrollees by Zip Code Area …..which is where most of the MediPass beneficiaries live. 9 PRELIMINARY FINDINGS – DO NOT QUOTE WITHOUT PERMISSION OF THE AUTHORS Figure 6 – MediPass Provider Service Areas The gray area represents areas within 30 minutes of a MediPass provider (also called service area). Most of Florida’s populated areas are within 30 minutes of a MediPass provider. A few small, wealthy communities are not within 30 minutes of a MediPass provider. 10 PRELIMINARY FINDINGS – DO NOT QUOTE WITHOUT PERMISSION OF THE AUTHORS Figure 7 – Ratio of MediPass Enrollees to Accepting Providers Located within a 30-minute Drive Time Gainesville, Lake City, Daytona Beach and Chiefland Panama City and Perry Most MediPass beneficiaries live within 30 minutes drive time of a primary care provider. However, some communities (identified by the blue squares) rely Ft. Walton Beach, Century, and Pensacola heavily on a few providers to deliver care to MediPass patients. MediPass patients could experience access barriers if these providers should withdraw from Medicaid. Port St. Lucie However, Medicaid areas with large numbers of providers may wish to consider downsizing their networks in Immokalee, Arcadia, and Okeechobee Key West and Marathon order to exert control over providers and to assure greater efficiency. 11 PRELIMINARY FINDINGS – DO NOT QUOTE WITHOUT PERMISSION OF THE AUTHORS Figure 8 - Ratio of MediPass Enrollees to Accepting Providers within a 30-minute Drive Time: Pensacola and Surrounding Areas Zip codes 32536 (Century), 32506 , 32505, 32501 (Pensacola) and 32547 (Ft. Walton Beach) have high enrollee to provider ratios . 12 PRELIMINARY FINDINGS – DO NOT QUOTE WITHOUT PERMISSION OF THE AUTHORS Figure 9- Ratio of MediPass Enrollees to Accepting Providers within a 30-minute Drive Time: Panama City and Surrounding Areas Zip codes 32401, 32404, 32405 (Panama City) and 32348 (Perry) have high enrollee to provider ratios. 13 PRELIMINARY FINDINGS – DO NOT QUOTE WITHOUT PERMISSION OF THE AUTHORS Figure 10- Ratio of MediPass Enrollees to Accepting Providers within a 30-minute Drive Time: Southwest Florida Zip codes 34142 (Immokalee), 34266 (Arcadia), 34972 and 34974 (Okeechobee) have high enrollee to provider ratios 14 PRELIMINARY FINDINGS – DO NOT QUOTE WITHOUT PERMISSION OF THE AUTHORS Figure 11- Ratio of MediPass Enrollees to Accepting Providers within a 30-minute Drive Time: North Central Florida Zip codes 32055 (Lake City), 32607, 32609(Gainesville) and 32177 (Palatka) have high enrollee to provider ratios. 15 PRELIMINARY FINDINGS – DO NOT QUOTE WITHOUT PERMISSION OF THE AUTHORS Figure 12 - Ratio of MediPass Enrollees to Accepting Providers within a 30-minute Drive Time: Fort Pierce and Surrounding Areas Zip codes 34950, 34982 (Ft. Pierce) and 34972 (Okeechobee) have high enrollee to provider ratios. 16 PRELIMINARY FINDINGS – DO NOT QUOTE WITHOUT PERMISSION OF THE AUTHORS Figure 13 - Ratio of MediPass Enrollees to Accepting Providers within a 30-minute Drive Time: The Florida Keys Zip codes 33040 (Key West) and 33050 (Marathon) have high enrollee to provider ratios. 17 PRELIMINARY FINDINGS – DO NOT QUOTE WITHOUT PERMISSION OF THE AUTHORS Figure 14 – MediPass Pediatric Provider Service Areas The brown color represent areas within 30 minutes of a MediPass pediatric provider. The green areas are not located within 30 minutes of a MediPass pediatric provider. Several communities, indicated by red dots are without a pediatric provider. 18 PRELIMINARY FINDINGS – DO NOT QUOTE WITHOUT PERMISSION OF THE AUTHORS Figure 15 – Ratio of MediPass Child Enrollees to Accepting Pediatric Providers Located within a 30-minute Drive Time Areas with high enrollee to pediatric provider ratios include Immokalee, Labelle, Okeechobee, Arcadia, Gainesville, Tallahassee, Pensacola, and Century. These areas have relatively few providers. 19 PRELIMINARY FINDINGS – DO NOT QUOTE WITHOUT PERMISSION OF THE AUTHORS Figure 16 – MediPass OB/GYN Provider Service Areas The pink area represents areas within 30 minutes of a MediPass OB/GYN provider. The green areas are not located within 30 minutes of a MediPass OB/GYN provider. Many communities, indicated by red dots are without OB/GYN physicians within 30 minutes. 20 PRELIMINARY FINDINGS – DO NOT QUOTE WITHOUT PERMISSION OF THE AUTHORS Figure 17 – Ratio of Adult Female MediPass Enrollees to Accepting OB/GYN Providers Located within a 30minute Drive Time Almost one-third the state appears to have a high patient to provider ratio. This may be an indication of poor access OB/GYN services among women enrolled in MediPass. 21 PRELIMINARY FINDINGS – DO NOT QUOTE WITHOUT PERMISSION OF THE AUTHORS References Adams EK, Bronstein JM, Florence CS (2003) The Impact of Medicaid Primary Care Case Management on OfficeBased Physician Supply I Alabama and Georgia Inquiry 40 (Fall 2003): 269-282. Berman S, Dolins J, Tang, SF and Yudkowsly B ( 2002) Factors that Influence the Willingness of Private Primary Care Pediatricians to Accept More Medicaid Patients Pediatrics 110(2 part 2): 239-248. Bindman AB, Yoon J, and Grumbach K (2003) Trends in Physician Participation in Medicaid. The California Experience Journal of Ambulatory Care Management 26(4): 334-343. Cunningham PJ (2002) Mounting Pressures: Physicians Serving Medicaid Patients and the Uninsured. 1997-2001. Center for Studying Health System Change. Tracking Report 6: 1-4. Florida Center for Medicaid Issue (2002) Evaluation of the Florida Medicaid MediPass Program, University of Florida, College of Public Health and Health Professions Perloff JD, Kletke P and Fossett JW (1995) Which Physicians Limit their Medicaid Participation and Why? Health Services Research 30 (1): 7 -26 McLafferty SL (2003) GIS and Health Care Annual Review of Public Health 24: 25-42. Schoenman JA and Feldman J (2003) Results of the Medicare Payment Advisory Commission’s 2002 Survey of Physicians. Washington DC: Medicare Payment Advisory Commission. 22 PRELIMINARY FINDINGS – DO NOT QUOTE WITHOUT PERMISSION OF THE AUTHORS 23 PRELIMINARY FINDINGS – DO NOT QUOTE WITHOUT PERMISSION OF THE AUTHORS APPENDIX 1 – DATA COLLECTION SHEET Provider Name: «PROVIDER_NAME» Phone: «OFFICE_PHONE» Address: «ADDRESS» City: «CITY» County: «County» Practice Type: «Practice_Type» Specialty: «Specialty» Attempt 1 Attempt 2 Date & Time Interviewer # Rings Phone Tree? Y/N # Transfers Hold Time Still Accepting New Patients (Stop if No) Still Accepting MediPass Patients (Stop if No) How long to Appt? (If >1 week) Even if sick? Taking Kids? Y/N After hours & Weekends? Courteous & Professional? VC, SC, SD, VD Comments Attempt 3 Attempt 4 25 PRELIMINARY FINDINGS – DO NOT QUOTE WITHOUT PERMISSION OF THE AUTHORS