Access, Insurance At Issue For Mass. Docs
Massachusetts officials can justifiably brag about the percentage of state residents who have health insurance — easily the highest in the nation at 95.2 percent of those between 18 and 64, according to one estimate.
But the Massachusetts Medical Society (MMS) warns that insurance is no good to someone whose doctor won’t take it.
Being Selective
The most recent MMS survey of the state’s physicians found that people on MassHealth plans may have a tough time finding a doctor. Only 53 percent of internists and 62 percent of family physicians take the insurance, which is the state’s Medicaid program, paid for with state and federal funds.
The percentages haven’t changed much in recent years, but as the persistently rocky economy leaves many people without employer-provided insurance, the issue becomes more significant. The total number of people enrolled in MassHealth rose 14 percent to 870,000 between December 2007 and June 2010.
One barrier that prevents many doctors from taking Medicaid plans is its relatively low reimbursement rates. Doctors are far more likely to accept Medicare, which typically pays providers more, and practically all of them take Blue Cross Blue Shield of Massachusetts, which is by far the dominant private insurer in the state.
“It’s very difficult when a patient calls to refuse them,” said Lynda Young, president of the Massachusetts Medical Society and a Worcester pediatrician. But Young said it can be difficult to take some plans, too.
“When reimbursement rates are low, it’s difficult to stay in business,” she said. “That’s the major issue. There are some plans that do well, and there are some that obviously don’t.”
Young said another aspect of practices’ decisions on accepting insurance is how many of their patients have a particular type. For a practice with just one or two MassHealth patients, she said, the administrative burden of dealing with the program might be too much.
Young said that particular problem is the subject of discussions between the MMS, insurers and state and federal agencies. She said most billing is now standard regardless of insurance plan, and getting more consistency in quality measures and in various forms would help make medical administration simpler, particularly for small practices.
“It would be much less time consuming, much easier,” she said.
The MMS survey found the lowest levels of acceptance for the new types of health plans created under the state’s 2006 health reform law, Commonwealth Choice and Commonwealth Care, but some say there could be problems with those survey results. Dick Powers, a spokesman for the Massachusetts Health Connector, which administers the Commonwealth programs, calls the results “seriously flawed.”
“I think there was some confusion on the part of the office managers who responded to the survey,” he said.
Powers said the problem is that the Commonwealth programs are simply a conduit for individuals to buy the same sorts of plans that are available to the employees of large companies. The Commonwealth Care plans are subsidized by the state, while enrollees pay for the whole cost of Commonwealth Choice plans.
The physicians’ practices that filled out the survey probably never know whether they’re seeing a Commonwealth Choice or Care patient since their insurance card would simply say the name of their private carrier, Power said.
Fallon Community Health Plan of Worcester said the network of doctors available to people who buy FCHP plans through Commonwealth Choice is exactly the same as for patients who get insurance through an employer.
Young said she doesn’t know whether the survey may have been flawed when it comes to the Commonwealth plans. But regardless of that particular piece of the results, she said it’s clear that there are a variety of barriers stopping patients from seeing the doctors they want to, and stopping doctors from seeing patients in their area who need care.
For his part, Powers said the data concerning the Commonwealth programs is the only part of the survey he takes issue with. Taken as a whole, he said, the survey, which also gathered information about how long patients must wait to see a doctor, shows that access to medical care is not as good as it could be.
“I think that speaks to the question, Are there enough primary care physicians?" he said.
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