Impact of Compensation, Performance Measures and Other Organizational Characteristics on Physicians’ Acceptance of New Medicaid Patients

Abstract

Medicaid plays a vital role in the U.S. health care system and the importance of office-based physician practices to the care of Americans served cannot be overstated. Despite increases in program enrollment, a number of sources report that the proportion of U.S. office-based physicians willing to accept new Medicaid patients is decreasing. This discovery is significant. This managerial accounting study utilizes a national survey of practicing physicians to explore this conundrum from the physicians’ perspective. Specifically, the impact of organizational-related determinants including (1) practice characteristics, (2) compensation and (3) performance measures is examined on physicians’ propensity to accept new Medicaid patients. With an empirical analysis using the cumulative odds ordinal logit model, this study breaks new ground in several significant venues. Only a limited number of studies have yet examined physician practice characteristics relative to physician acceptance of Medicaid, but these were far more limited in scope. In addition, this study offers a first look at how financial and non-financial incentives collectively impact patients’ access to Medicaid. Finally, it is important to point out that this study provides for a comprehensive look at understanding what organizational characteristics help to determine the probability of physician acceptance of new Medicaid patients.The most significant factors found to be associated with diminished propensity for Medicaid access include: operating as a primary care doctor, physician ownership in the practice, practice size, low relative geographic reimbursement, supportive clinical IT and gender. Knowing what factors are associated with physicians’ decisions should provide opportunities for potential public policy solutions.