The States' Next Challenge — Securing Primary Care for Expanded Medicaid Populations

Ku, Leighton; Jones, Karen C.; Shin, Peter; Bruen, Brian; Hayes, Katherine J.

doi:10.1056/nejmp1011623

Cited by 85 publications

(47 citation statements)

References 1 publication

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“…4,5 There is broad participation in Medicaid by primary care physicians currently. However, few physicians now serve large numbers of Medicaid patients.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3] The expected influx of newly insured adults into the health care system under health reform has raised concerns about the ability of the existing primary care workforce to meet the increased demand for care. This is of particular concern for the Medicaid program, 4,5 where limited provider participation has long been an issue and gaps in access to care are common. [6][7][8][9][10][11] The Affordable Care Act includes a number of provisions to expand access to primary care in the program, including temporary increases in Medicaid payments to primary care providers and expanded funding for federally qualified health centersa frequent source of care for Medicaid enrollees.…”

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confidence: 99%

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Physicians May Need More Than Higher Reimbursements To Expand Medicaid Participation: Findings From Washington State

Long

2013

Health Affairs

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The expansion of insurance coverage under the Affordable Care Act is expected to put considerable pressure on the capacity of the primary care workforce to meet the needs of the Medicaid population beginning in 2014. The results from a 2011 survey and focus-group sessions with Washington State primary care physicians suggest that doctors welcome planned increases in Medicaid reimbursement rates. However, the data also show that other approaches could be even more effective in increasing physicians' willingness to see Medicaid patients. Those approaches include lowering the costs of participating in Medicaid by simplifying administrative processes, speeding up reimbursement, and reducing the costs associated with caring for those patients. In focus groups, physicians were cautiously optimistic about the potential of the Affordable Care Act to make a difference in each of these areas, with electronic health records, medical homes, and accountable care organizations all seen as promising developments.

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“…4,5 There is broad participation in Medicaid by primary care physicians currently. However, few physicians now serve large numbers of Medicaid patients.…”

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Physicians May Need More Than Higher Reimbursements To Expand Medicaid Participation: Findings From Washington State

Long

2013

Health Affairs

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“…[1][2][3][4] Other work has used models that emphasize the important role of nonphysician providers such as physician assistants and nurse practitioners in primary care. 5 Yet both sets of models have a key shortcoming: In general, they assume that the current "production function" for primary care services-specifically, the number and type of providers required to provide primary care to a given population-is fixed.…”

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confidence: 99%

Nurse-Managed Health Centers And Patient-Centered Medical Homes Could Mitigate Expected Primary Care Physician Shortage

et al. 2013

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Numerous forecasts have predicted shortages of primary care providers, particularly in light of an expected increase in patient demand resulting from the Affordable Care Act. Yet these forecasts could be inaccurate because they generally do not allow for changes in the way primary care is delivered. We analyzed the impact of two emerging models of care-the patient-centered medical home and the nursemanaged health center-both of which use a provider mix that is richer in nurse practitioners and physician assistants than today's predominant models of care delivery. We found that projected physician shortages were substantially reduced in plausible scenarios that envisioned greater reliance on these new models, even without increases in the supply of physicians. Some less plausible scenarios even eliminated the shortage. All of these scenarios, however, may require additional changes, such as liberalized scope-of-practice laws; a larger supply of medical assistants, licensed practical nurses, and aides; and payment changes that reward providers for population health management.

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“…Particular concern has focused on anticipated shortages of primary care physicians nationally (Anderson & Horvath, 2004;Bodenheimer & Pham, 2010;Colwill et al, 2008;Ku, Jones, Shin, Bruen, & Hayes, 2011;Nicholson, 2009;Petterson et al, 2012;Sargen, Hooker, & Cooper, 2011) and in specific regions of the country (Huang & Finegold, 2013). Most of the studies that report current and impending primary care shortages have focused exclusively on primary care physician supply.…”

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confidence: 99%

How Many Nurse Practitioners Provide Primary Care? It Depends On How You Count Them

Spetz

Fraher

et al. 2015

Med Care Res Rev

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This study compares different approaches to measuring the number of nurse practitioners (NPs) providing primary care services using data from the 2012 U.S. National Sample Survey of Nurse Practitioners, North Carolina licensing data from 2011, and a 2010 California survey of nurse practitioners and nurse midwives. Estimates of the number and share of NPs providing primary care depend on how one defines primary care. If the definition is based on the field of NP education, the estimated shares in primary care specialties are 83.5% in North Carolina and 90.7% in California; if the definition is based on current or past fields of certification, the estimated shares are 79.9% in North Carolina and 74.5% nationally. The estimated number is even smaller if one considers employment setting (58.4% in North Carolina, 66.8% in California, and 67.8% nationally), and shrinks to about half of NPs if focusing on current field of clinical specialization.

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The States' Next Challenge — Securing Primary Care for Expanded Medicaid Populations

Cited by 85 publications

References 1 publication

Physicians May Need More Than Higher Reimbursements To Expand Medicaid Participation: Findings From Washington State

Physicians May Need More Than Higher Reimbursements To Expand Medicaid Participation: Findings From Washington State

Nurse-Managed Health Centers And Patient-Centered Medical Homes Could Mitigate Expected Primary Care Physician Shortage

How Many Nurse Practitioners Provide Primary Care? It Depends On How You Count Them

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