Provider Participation in Medicaid: All Over the Map

The other day, the media gave good coverage to a report by a Dallas consulting firm, Merritt Hawkins, which surveyed waiting times for specialists in U.S. urban areas. Reporters were shocked to see waiting times measured in weeks, but in Canada, the waiting times are months. Look at the Fraser Institute’s latest waiting time survey (2008): 36.7 weeks for orthopaedic, 16.1 weeks for gynecologic, 12.5 weeks for internist, 7.3 weeks for cardiovascular, etc. And these are not for the operations: These waiting times are from the date your primary-care doc refers you until your first consultation with the specialist.

In the Merritt Hawkins survey, waiting times average about three weeks!

What the media generally ignored was doctors' participation in state Medicaid programs: It is all over the map. Overall, 55% of surveyed doctors reported participating in Medicaid, but there is huge variation across cities, and differences between the recent results and those from five years ago.

For example, 11% of surveyed cardiologists in Boston reported accepting Medicaid patients n 2004, versus 100% in 2009. On the other hand, 80% of Philadelphia cardiologists reported Medicaid participation in 2004, but only 8% did in 2009!

This remarkable instability is hard to understand. It indicates that Medicaid is out-of-control, changing reimbursement policies erratically and dramatically. It's certainly no model for health reform.