On Tuesday, a report issued by the Health and Human Services (HHS) department revealed that half of the doctors listed as being affiliated with a Medicare health plan could not provide medical services to Medicare enrollees. The motives ranged from not living at the specified address to patient overload.
However, the federal inspectors said these incidents raised questions about the effectiveness the Affordable Care Act in granting access to care for Medicaid patients.
“Half of providers could not offer appointments to enrollees,”
the health inspectors said.
Last year, the new health law encouraged up to nine million people to enroll in Medicaid plans. Most of the new Medicaid patients opted for private health plans where they could choose their doctors from a list containing Medicaid health providers.
The federal investigators wanted to learn if the system was smoothly running and started calling several doctors’ offices and requested an appointment. Nevertheless, many of these doctors were either unavailable, either unable to provide appointments for Medicare beneficiaries.
Thirty-five percent of the doctors couldn’t be reached at the location listed in the Medicaid plan.
“In these cases, callers were sometimes told that the practice had never heard of the provider, or that the provider had practiced at the location in the past but had retired or left the practice. Some providers had left months or even years before the time of the call,”
Daniel R. Levinson, inspector general for HHS, said.
About eight percent of the doctors were found at the locations listed but, although they were supposed to accept Medicaid patients, they said they did not take part in such a health plan. Another eight percent of the doctors said that they couldn’t accept new patients due to patient overload.
Mr Levinson said that when doctors participating in the Medicare plan refused to provide appointments to enrollee, this was a significant obstacle for the beneficiary in seeking care. Also, the HHS inspector general was concerned by the efficiency of provider networks. He now believes that these networks may be a lot smaller than previously suggested in the Medicaid plans.
The federal inspectors dialed about 1.800 health providers listed in over 200 Medicare plans across 32 US states.
The doctors who did provide appointments had very long waiting periods. Inspectors found that the average appointment wait time for medicare patients was 2 weeks. Over 25 percent of them had wait times longer than 1 month, while 10 percent were surpassing 2-month-long wait times.
This can lead to sever implications for the patients. For instance, some obstetricians had waiting periods longer than 1 month, while one of them had a 2 months wait time for a Medicaid women who was already eight weeks pregnant. HHS inspectors said that the lengthy waiting period could deprive women in a similar situation of prenatal care in the first trimester.