More than one-fourth of doctors enrolled in Medicaid did not deliver care to any Medicaid beneficiaries in 2021, adding to concerns about low physician participation in the safety-net insurance program, according to new research published in Health Affairs. Almost 28% of doctors enrolled in Medicaid were “ghost providers” and did not treat a single patient that year. Another 10% treated fewer than 10 patients, while the remaining 62.2% were standard or “core” providers treating the bulk of Medicaid enrollees.
Participation varied widely by specialty. Psychiatrists were most likely to be ghost providers, while primary care physicians and cardiologists were least likely. The median psychiatrist saw just three unique Medicaid patients in 2021, and more than 40% of psychiatrists were “ghosts” who saw no Medicaid enrollees over the study’s term. This is particularly concerning in behavioral health, where Medicaid beneficiaries are more likely to be seriously mentally ill.
Barriers and Explanations
Medicaid is the largest public insurance program in the U.S., covering roughly 71 million Americans. However, beneficiaries face pervasive roadblocks to accessing care. According to the congressional advisory group MACPAC, only 74% of U.S. doctors accepted new Medicaid patients in 2017, compared with 88% for Medicare and 96% for private insurance. Many physicians cite Medicaid’s low reimbursement rates as the reason, arguing they make participation financially unsustainable.
Researchers noted multiple explanations for why doctors might be enrolled in Medicaid but see few patients. Some physicians may be enrolled because their employer requires it, or because health insurers they contract with require it. Others who don’t see many Medicaid patients might not treat many patients overall, may be moving or retiring, or may not be accepting new patients due to staffing shortages. Whatever the reason, the study shows the risk of burnout among “core” providers, which take on the lion’s share of caring for Medicaid patients. Researchers suggested policymakers work to improve Medicaid participation, especially in behavioral health, through higher reimbursement or other incentives to get clinicians to treat more Medicaid patients.
This article is an AI-assisted summary. All facts and figures are drawn from the original report: https://www.healthcaredive.com/news/medicaid-ghost-providers-study-health-affairs/811261/