Determinants of physicians' acceptance of new medicare and medicaid patients
Taking a comprehensive look at understanding what organizational characteristics impact physician propensity to take on new Medicare and new Medicaid patients will be of central concern to this study. Understanding the underlying financial pressures that pose greatest threat to limiting physicians will be further examined.
Data/Methods:
This study will examine a national sample of physicians utilizing the Center for Health System Change’s 2008 restricted-use file for the Health Tracking Physician Survey.
Cumulative odds ordinal logistic regression will be employed to clarify trends in the ordinal outcomes: probability of physician acceptance of new Medicare patients and probability of physician acceptance of new Medicaid patients. Three ordinal logit models will separately examine the organizational characteristics of practice ownership, size, marketplace environment and information technology, second physician compensation and thirdly financial and non-financial performance measures.
In exploring the follow-up question regarding the financial pressures of physicians that limit acceptance of new Medicare and Medicaid patients, Friedman’s two-way analysis of variance by ranks will be employed.
Discussion
Despite increases in beneficiary enrollment in both government supported programs, several sources report that the proportion of US office-based physicians willing to accept, and by extension treat, Medicare and Medicaid patients is decreasing.
There is a need to explore this issue from the unique position of the office-based physician as they perform clinical services to Medicare and Medicaid patients in a variety of organizational settings of differing size, location, scope and ownership, Moreover, given the multidimensional aspects of a physician’s job, insight into financial incentives on physician behavior is needed with regard to influence on acceptance or lack thereof of new Medicare and new Medicaid patients. Physician performance measures and compensation arrangements will be explored with agency theory providing the construct in which to view the behavior of individuals who contract for a service and the individuals who in fact provide the service. This study will provide for a firsthand look at the use of performance measures in compensation contracts on the issue of access for new Medicare and Medicaid patients.